Routine inspection (multi-day)·April 29, 2025

Licensing Program Analyst (LPA) Daniel Konishi conducted the Unannounced required annual inspection. LPA arrived unannounced and met with the Executive Director, Mary Mims-Burris and assisted with the visit. The purpose for the visit was explained. The facility is licensed for residents ages 60 and over. The fire clearance is approved for 49 ambulatory and 111 non-ambulatory. Currently, the facility has 11 hospice waiver residents and 6 home health residents. The initial annual visit was conducted on 04/24/2025. During the initial visit the following eight (8) Compliance and Regulatory Enforcement (CARE) tool domains were observed and reviewed: Infection Control, Operational Requirement, Physical Plant Environmental Safety, Resident Right-Information, Planned Activities, Food Services, Incidental Medical and Dental, Disaster Preparedness. During today’s annual visit, the following four (4) Compliance and Regulatory Enforcement (CARE) tool domains were observed and reviewed: Staffing, Personnel Records-Training, Resident Records-Personnel Reports, Resident with Special Health Needs. Staffing: Facility has sufficient staffing for care and supervision to the residents. Personnel Records-Training: All the staff in the facility are over 18 years old and fingerprint cleared with the facility. The administrator is Mary Mims-Burris and her administrator certificate expires on 10/02/2025. LPA reviewed all nine (9) staff files and they all have the required documents in file which included: health screening, TB test result, employee rights, required training hours and updated first aid certificate. Resident Records-Incident Reports: LPA inspected eleven (11) residents files which include eight (8) residents files from Assisted Living and three (3) residents files from Memory Care and they all have the required documents in file which included: admission agreements, Physician's Reports, Updated Needs and Service Plan, Pre-appraisal, TB clearance, Physician’s Orders, Personal Rights, and medication records. Resident with Special Health Needs: No residents in the facility with prohibited health conditions. No residents in the facility with postural supports. Currently there are eleven (11) residents on hospices and six (6) residents on home health. Individual Service Plan and appraisals are on resident's files for home health and hospice. There are interior and exterior space available on the facility premises to permit residents with dementia to wander freely and safely. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies observed during the visit. Exit Interview conducted and a copy of the report were provided to the Executive Director, Mary Mims-Burris.