Routine inspection·September 9, 2025

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by Licensee (LE), Victor McKenzie and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for three. Currently there are five residents, of which three are on hospice during today's visit. LPA Tea reviewed five resident files and two staff files. Resident files had the required documentation. There were discrepancies in staff files. LPA observed outdated First Aid/CPR training. There is current staff training for one staff last conducted in November 2024. Licensee misplaced the current training for the other staff. There is currently no qualified administrator. The designated administrator nor licensee does not have a valid administrator certificate. LPA Tea along with the licensee toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms were missing and some did not operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. At first the bathrooms did not have good up keeping but caregivers cleaned up the restrooms afterwards. LPA reminded licensee to maintain the cleanliness of the bathroom and facility. There should be no cobwebs, spiders and other insects at all. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured around 119.3 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was (Annual report continued on LIC809C) inspected. Perishable and non-perishable food supply was checked and adequately stocked at the time of visit. LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be locked and inaccessible to residents in care under the kitchen sink and in cabinets by the laundry area. The fire extinguisher in the kitchen is fully charged. The kitchen appliances are operational. LPA toured the outside grounds and there is ample seating with shade and two exit gates on both sides of the facility are self-latching and operational. LPA observed not enough emergency supplies for 72-hour reliance. The emergency food was expired. There was not enough water for residents during an emergency disaster. Facility provides activities based on resident interests and health conditions. They play small ball games and do body exercises, especially chair exercises. At the time of annual visit, residents were seen having lunch, watching television in the living room and family visitors came to visit. LPA reviewed medication storage and administration. Medications are not stored in a secured centrally stored location. Medications are being administered per physician order. Medications are not tracked properly or have proper consistent record keeping like with a centrally stored medication list. LPA interviewed residents regarding their quality of care and spoke to staff present regarding the care provided. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Licensee Victor McKenzie and a copy of these reports were given to the facility along with a copy of the LIC 858; 859;809-D, 9102TV and Appeal Rights.