Routine inspection·March 10, 2026

Licensing Program Analyst (LPA) Cuadra conducted an unannounced required annual inspection of this facility and case management to cite deficiencies discovered during a complaint investigation # 21-AS-20260126092155 met with facility Administrator Kathleen Devera. Annual fees current. LPA learned through records review and interviews with Administrator while investigating complaint # 21-AS-20260126092155 that the facility has failed to follow up when resident (R1) reported to staff (S1, S2 & S3) on 1/19/26 at 2:09pm an alleged “abuse” has occurred. According to the Administrator, R1 has a history of been aggressive to staff, so it was presum ed as another unfounded incident. On 12/12/25 there was another incident involving another resident (R2) where it was reported to facility management that staff (S4) was no longer welcome to care for R2 due to their incompetency when providing care and been always in a rush, getting defensive and other complaints that other staff raised about them, which resulted in management conducted an internal investigation and provided a written warning. LPA reviewed incident reports submitted to the Department and there were no incident reports regarding any of these reports. LPA/Administrator toured the building and grounds: The main building is two stories and currently there are eleven residents residing downstairs and four residents upstairs. Second building is single story and currently there are three residents. There were two staff and housekeeper staff present in the second building providing care and supervision to residents in care. Continue on LIC809C... Continued from LIC809... At approximately 10:00 am, LPA/Administrator observed that the elevator was last inspected on 11/20/23 and permit expired on 11/20/24. Per Administrator, they just came this week to inspect it, but there was no proof of service given. At approximately 10:15am, LPA/Administrator while touring the facility did not hear the auditory alarm when opening the door leading to second building located in the back of the facility. Per Administrator, the auditory alarm was not working and its being repaired. At approximate 10:30am LPA/Administrator observed hot water measurements of 78.8, 77.7, 135.5, 124 and 108.3 degrees which is not within regulation between 105 and 120 degrees F at faucets used by residents in care. Bathrooms have non-skid surfaces and grab bars at the toilet and shower areas. All medications were all locked and inaccessible to residents in care. Facility has cameras in both buildings in common areas. All common areas, hallways, and bathrooms observed had sufficient lighting. Residents rooms are furnished per regulation. The facility is on a delayed egress system and a locked perimeter courtyard for resident's use, which it was approved in their fire clearance. Evacuation chair was observed in the stairwell and documented in the facility emergency plan as indicated by the Department. The facility was a comfortable temperature. Passageways were free of obstructions. Facility has a sufficient supply of cleaners, hygiene items and paper products. Multiple first aid kits were observed. A call button is located in each bathroom and they are operational to alert staff. The amount of fresh and nonperishable foods is within regulation. A tour and inspection of the kitchens and dining areas were found to be clean and sanitary. Refrigerators and freezers were at required temperatures. Prepared and left over foods were covered and labeled. Menu includes a wide variety of foods from all of the food groups. A board in the kitchen has written instructions for residents with food allergies and restricted diets. The facility has emergency supplies, including food and water to meet requirements of the 72-hour shelter in place. The facility has a generator in case of power outages. Continue on LIC809C... Continued from LIC809C... Residents were observed participating in group activities in common areas. Fire extinguishers inspected were charged and dated 3/18/2025. Smoke detectors were tested in resident rooms. Facility has fire sprinklers throughout. Carbon Monoxide detectors were present and operational. The last disaster drill was conducted on 2/3/26. There were two garbage cans that do not have a lid/cover and ant observed in main bathroom located in the second building in the back of the facility (technical violation issued). At 11:00 AM, LPA conducted a file review of ten residents and five staff. One out of five staff (S4) do not have a health screening form on file including their TB test (technical violation issued). Three out of five staff (S1, S3 & S5) do not have current 1st aid or CPR certificates updated. All staff have completed all required training hours. Residents receiving hospice services had a care plan that appears to be accurate to services being provided. All residents' care plans seems to have a person-centered approach and they are updated. Medical assessments are current and included a description of any known behavioral expression. One out of ten residents (R2) does not have half bed rails order on file (technical violation issued). Kathleen Devera, administrator certificate 6069816740 expires on 10/18/2026. Medication is centrally stored and locked in medication cart located at the medication room. A sample of medication and medication records reviewed. Updated copies of the following documents need to be submitted to CCL by not later than 3/23/26: LIC500- Personnel Report. LIC308- Designation of Responsibility. LIC610E- Disaster Plan (if there are any changes). Evidence of Liability Insurance. Deficiencies are cited from the California Code of Regulations (CCRs), Title 22, Division 6, Chapter 8 and the Health and Safety Code. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal Rights Given. Exit interview was conducted with Administrator and a copy of this report was given.