Routine inspection·August 21, 2025

Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced Required- 1 year visit. LPA was met by Richel Feria, the Caregiver and explained the purpose of the visit. The Administrator, Cherie Wood arrived shortly after and the LPA explained the purpose of the visit. Facility is licensed for residents the age range of 60 and over. Six (6) non-ambulatory of which one (1) may be bedridden in room #5. Hospice waiver for four (4) residents. There are (1) bedridden and (1) hospice residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility has an updated infection control plan dated 11/01/2024 in place. The facility staff and residents continue to practice hand washing and disinfecting the facility each shift. The facility has sufficient PPE supplies. Operational Requirements: Facility is licensed for residents the age range of 60 and over. Six (6) non-ambulatory of which one (1) may be bedridden in room #5. Hospice waiver for four (4) residents which is within the fire clearance requirement. LPA observed current Liability insurance in place. The facility has a dementia care plan to accept or retain residents with dementia. The fire drill was last conducted on 06/17/2025. Physical Plant/Environment Safety: A tour of the single-story facility included: four (4) resident bedrooms, one (1) staff bedroom, one (1) resident bathroom, living room, kitchen, laundry room, front yard, backyard, and attached garage. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. The front and backyard are well maintained. Physical Plant/Environment Safety: There is a shaded seating area for the residents located in the backyard. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested and measured at 119.1 degrees F, which is within the required 105 - 120 degrees F. Sharps are kept locked in a kitchen cabinet. Chemicals and cleaning supplies are kept locked under the kitchen sink. The bathroom was clean and had the required grab bars in the shower and near the toilet for non-ambulatory residents. The shower has non-skid material. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in the hallway. Smoke detectors were observed in each room and throughout the facility and are properly operating. A carbon monoxide detector was tested and properly operating. A fire extinguisher was observed at the kitchen and is fully charged. Staffing: The facility has sufficient staff to provide care and supervision to the residents. The staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Personnel Records-Training: LPA reviewed five (5) staff files that include: Personnel Record, Health clearance, TB Result, Criminal Background Clearance, Employee Rights, 1st Aid/CPR training, Medication Management and Staff Training. The RCFE administrator certificate expired on 08/19/2027. Resident Rights-Information: Resident personal rights, complaint hotline information and visitors’ policy posters are posted. Per Administrator, facility provides internet services to all residents and have access to the facility phone. Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. LPA observed sufficient equipment and supplies to accommodate residents with special needs to meet the requirements of the activity program. Food Service: Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Sufficient food supply is stored in the kitchen consisting of 2-day perishables, 7-day non-perishables, and emergency food supplies. Pesticides and cleaning supplies are kept away from the food preparation areas. Per administrator, there are no residents that have a modified diet. Incident Medical and Dental: Medications were reviewed for six (6) residents to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are centrally stored and in their original containers. Medications are administered as prescribed by the Physician. Medications are bubbled packed. LPA reviewed six (6) residents medication files and observed the Centrally Stored Medication Destruction Record in file. The first Aid kit was observed and has all required items. Resident Records/Incident Reports: LPA reviewed five (5) resident files that include: the Face Sheet, Admission Agreements, Physician's Reports, TB Clearance, Ambulatory Status, Pre-Placement Appraisal, Functional Capability Assessment, Resident Appraisal, Physician’s Orders, Appraisal/Service and Needs Plan, and Personal Rights. Disaster Preparedness: Emergency and Disaster Plan LIC 610E dated 08/01/2025 is in place with contact numbers and at least 2 relocation sites. Residents with Special Health Needs: There are no residents receiving home health services and one (1) resident receiving hospice care. The facility has a hospice care plan. There are no residents with prohibited health conditions. Based on record review, LPA observed that Resident #1 (R1’s) file did not have a written Physician’s Order for a half bed rail. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809-D. Exit interview, appeals rights and a copy of this report were provided to the as provided to Cherie Wood, Administrator.