Routine inspection·May 9, 2025

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Rosehaven I. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, of which one may be bedridden. Facility has an approved hospice waiver for 5 residents and the home currently has 3 residents with none on hospice during today's visit. Administrator Jaya Pichika has a current administrator certificate expiring on 09/13/2025. LPA Lyman along with Caregiver Larry Espinol toured the facility at 10:58 AM. Administrator Jaya Pichika arrived during the visit. LPA toured the physical plant, checked food service, reviewed records and the first aid kit. Facility appears to be clean, safe, and sanitary. The home consists of six resident bedrooms, one resident restroom, two common restrooms, one staff room, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed two residents with a half bed rails. Resident restrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. At 11:05 AM, LPA observed there are missing drawer pulls in the master restroom. Water temperature measured between 109.4 and 111 degrees F in all facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including tweezers, thermometer, and scissors. The entry door into the garage is secured. LPA observed a locked storage area for cleaning supplies. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. Four out of six smoke detectors are inoperable. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. CONT ON LIC809-C DATED 05/09/2025 LPA toured the outside grounds and there is ample shaded seating for residents. At 11:15 AM, LPA observed the exit gate does not latch shut. LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan during the visit. Plan is thorough and complete. Facility provided documentation of last fire drill conducted on 04/25/2025 and drills are conducted quarterly. Facility provides activities in the form of exercise and games. At 11:30 AM, LPA reviewed three resident files and three staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. Resident 2 does not have a current medical assessment in the file and two out of two residents with bed rails do not have a physician order for rails. One out of three staff do not have a personnel file and three out of three staff do not have current training. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet and are being administered per physician order. Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.