Routine inspection·April 17, 2025

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is a three level structure and is licensed for 132 residents, of which 3 may be on hospice and 0 may be bedridden. Administrator (AD) Edward Maslobodsky arrived shortly to help conduct the visit. AD has a valid certificate that expires on 5/15/2025. LPA along with staff toured the facility at 9:00 AM. LPA toured the physical plant, checked food service, and facility documentation. LPA toured a total of 8 random resident bedrooms of which, resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Water faucets worked properly, grab bars were secure and showers were free of mold/mildew. Water temperature measured between 116.2 degrees F and 119.3 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. At 11:10am, LPA observed medication pills in a clear plastic cup located in the bathroom shelf for Resident 2 (R2). LPA toured the kitchen, perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Fire deterrent system was last serviced on 4/15/2025. Fire extinguishers observed were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts monthly emergency drills with the last drill conducted on 3/25/2025. LPA observed evacuation chairs, one for each stair way. Outside grounds were toured. There is shaded outdoor seating for residents. Continued on LIC809C dated 4/17/2025 First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise, puzzles, and bingo. Exit gates are unlocked and operational. LPA observed the emergency food and water supply. LPA reviewed eight resident files and six staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in medication carts and in the medication room. Based on the observations made during today’s visit, a deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.