Routine inspection·September 15, 2025

Licensing Program Analyst (LPA) Daniel Konishi conducted the required annual inspection. LPA arrived unannounced and met the Administrator, Jennifer Serrano and the LPA explained the purpose of the visit. The facility is licensed to serve 70 Ambulatory (of which 50 may be Non-Ambulatory) residents ages 60 and over. With an approved hospice waiver for 20. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents’ medications. Staff are still cleaning and disinfecting throughout the day. The facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Operational Requirements: The facility maintains a current Plan of Operation and an approved Fire Clearance. The facility maintains the required Liability Insurance. Physical Plant & Environment Safety: This is a two-story facility includes: First Floor: Front Office, Conference Room with Storage Room and File Room, Activity Room, Storage Closets Under Parking Port, Laundry Room, Dining Hall, Kitchen, Medication Room, Linen Closet and Outdoor Patio Areas. There are 3 buildings on the first floor (A, B, F&G) totaling 16 Resident Rooms, 6 Full Bathrooms, 4 Half Bathrooms. Second Floor: 3 buildings totaling 28 Resident Rooms, 8 Full Bathrooms, 4 Half Bathrooms, Patio Area and Storage Closets. There are call buttons in and smoke detectors in each unit and there is an emergency sprinkler system throughout the facility. LPA toured facility, a total of 11 residents’ bedrooms/units were checked and had the required closet/drawer space to accommodate each resident comfortably available. Physical Plant & Environment Safety (continued): LPA observed two (2) evacuation chairs that were mounted nearby the stairways. The residents’ rooms each had a signal system with call buttons that were tested and operating properly. There are smoke detectors, carbon monoxide detectors and an emergency sprinkler system throughout the facility that are operable and in compliance. The fire extinguishers observed are fully charged and last inspected on 11/22/2024. No bodies of water were observed at the facility. Hot water temperature was tested in 11 bathrooms throughout the facility and measured from 105.2 degrees F to 118.4 degrees F which are within the required range of 105-120 degrees F. The passageways are free of debris/hazards and are free of obstruction. All storage areas for cleaning solutions, toxins, knives, and hazardous items that are properly stored are inaccessible to residents. Staffing : There appears to be sufficient staffing at all times with at least one night-time staff that is able to operate the facility signal system, is familiar with emergency procedures and has current CPR and First Aid training on file. Personnel Records-Training : LPA reviewed five (5) staff files which includes personnel record, criminal record clearance, health screening, TB clearance, valid First Aid/CPR/AED training, Employee Rights, dementia training, and sufficient on-going training. Administrator’s certificate expired on 03/12/2027. Resident Rights-Information: Personal Rights and Complaint signage are posted within the Dining Hall. Resident Records-Incident Reports: LPA reviewed seven (7) resident files that include: Admission Agreements, Identification & Emergency Information, current Physician's Report, TB Clearance, Ambulatory Status, Pre-admission appraisal/Appraisal Needs & Services Plan, and Personal Rights. Planned Activities: LPA observed the Activity Schedule posted in the Dining Hall and toured the Activity Room, there were books, magazines, supplies for activities, board games and puzzles readily available for residents. The facility has a designated Activity Director. Food Service: The kitchen was observed for its ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medications are centrally stored in locked Medication Room and in their original containers. LPA reviewed seven (7) residents’ medications and there were no issues. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. The facility maintains documentation of the required emergency drills. The last Fire Drill was conducted on 07/24/2025. Residents with Special Health Needs: The facility is in communication with the Home Health agency to ensure the needs of residents are being met. There are currently no residents under hospice service. LPA observed half bed rails in Resident #4 (R4's) bedroom and physician's order for a half bed rail for Resident #4 (R4) was not in file. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on 809D. Exit interview was held and a copy of the report and appeal rights were provided Administrator Jennfier Serrano.