Routine inspection·February 25, 2025

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to staff Cynthia Tadeo. The following domains were completed: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. An Infection Control Plan was observed Physical Plant/Environment Safety: The facility is located in a residential neighborhood. The facility includes a staff office, laundry room, dining area, common area/TV room, staff bathroom, (6) residents bedrooms and (6) resident bathrooms and a detached garage. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. There are no bodies of water in the facility. Water temperature readings measured within title 22 regulations. Operational Requirements: A current Plan of Operation was observed. Fire clearance approved for (9) residents with age range 60 and over. Clearance is approved for up to (9) Non-ambulatory and has an approved hospice waiver for up to five (5) residents. Facility has an active liability insurance. Copy was collected and reviewed Personnel Records - Staff Training: Administrator on file is current. Administrator certificate is currently active Four (4) staff files were reviewed. Required documents observed for files reviewed. Staffing: Sufficient staff observed during visit Night Shift staff sufficient. Continued on LIC 809-C Resident Records - Incident Reports: A total of Five (5) resident files were reviewed. Required documents observed Resident Rights - Information Required postings observed Facility provides internet services to residents in care Food Service: Sanitation practices and kitchen cleanliness was observed. Kitchen has utensils for clients to use and to store their meals Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Activities supply observed Incident Medical and Dental: Emergency transportation available First Aid Kid observed Five (5) Resident medications were reviewed. Disaster Preparedness: Emergency and Disaster Plan observed Emergency drill last conducted 1/10/2025 Residents with Special Health Needs: Needs and Services Plans are on file for all residents. There are no residents receiving home health services Currently One (1) Resident is on hospice. Hospice service agreement observed Inspection Tool was completed and per Title 22 there are no deficiencies being cited on todays visit. Exit interview conducted. Copy of this report was provided.