Routine inspection·April 28, 2025

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Maria Go and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 7:45AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 5-bedroom, 3-bathroom, one-story house with an attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 1 staff and 1 resident present at the facility in addition to AD. Resident Bedrooms: the 2 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the 3 staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 118 degrees F in the resident bathroom. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the laundry room. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 8:45AM, LPA reviewed 1 resident file and 3 staff files, interviewed 1 staff, and inspected medications for 1 resident. Facility does not handle resident money. CONTINUED During the inspection, LPA and AD observed the following: based on documents, AD's first aid and CPR training expired in December 2024 and there are no other staff present with current training; based on observation and admission, the licensee did not ensure S1, AD's family member who is visiting AD and has been here for one day, was background cleared; based on documents, the licensee did not ensure 2 out of 3 staff had the required 20-hour annual training within the last year; and based on observations, the licensee did not ensure the fire extinguisher had been inspected within the last year Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421BG. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.