Routine inspection·May 21, 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 licensed for 40 non-ambulatory residents of which 15 may be bedridden. Facility has an approved hospice waiver for 15 residents. Administrator (AD) Rose Nakadaira arrived shortly to facilitate visit. AD provided updated liability insurance that expires on 06/01/2025. LPA along with staff toured the facility at 9:30 AM. LPA toured the physical plant, checked food service, and facility documentation. The facility consists of 22 resident bedrooms, living areas, dining room/activities room, prep kitchen and full kitchen as well as 8 shared resident bathrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed there is no resident signal system in the resident bedrooms. At 10:30am, LPA observed missing smoke alarm in room 19. Resident bathrooms were checked. Toilets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 89.9 degrees F and 119.8 degrees F in all bathrooms checked. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. At 9:50 am, LPA observed fruit flies hovering in the prep kitchen next to the activities room. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPA toured the full 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 extinguishers were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Outside grounds were toured. Walkways around the facility were clear of hazards. There is shaded outdoor seating for residents. Exit gate is unlocked and operational. Continued on LIC809-C dated 05/21/2025 LPA observed the emergency food and water supply. LPA reviewed five resident files and five staff files. All resident files contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders for bed rails as indicated. 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 a locked cart. Medications are being administered per physician order. Facility did not have fire system maintenance records dated within the last 12 months. Facility did not have records of emergency drills occurring within the last 3 months. Based on the observations made during today’s visit, deficiencies are 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.