Routine inspection·June 16, 2025

On June 16, 2025, at 1:00pm, Licensing Program Analyst (LPA) Eboni Bentley conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Bentley was greeted and granted entry by Caregiver (CG) Connie Martinez after explaining the purpose of the visit. Administrator Lawrence Lindsey was contacted by telephone and stated he was available by phone, as needed. AD Lawrence Lindsey has an administrator certificate with an expiration date of December 25, 2025. The facility is licensed to operate for six (6) non-ambulatory, of which one (1) may be bedridden and a hospice waiver for three (3) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, living area, dining area, kitchen, an attached garage, and outside covered patio area. There are five residents on census, all present during today’s visit. LPA obtained copies of pertinent documents, including facility records, clients/staff rosters and Personnel Record (LIC500). During the visit, LPA Bentley toured the interior and exterior of the physical plant with CG Martinez and observed the facility to be appropriately furnished at the time of visit. Sharp objects were stored and locked. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available. LPA observed unsanitary conditions in the kitchen and bathroom, the garage full of storage and clutter, and there is only one exit gate in the backyard, which is in need of repair. LPA also observed multiple areas in the garage where toxins are stored in the same area as food items. CONTINUE TO LIC 809-C PAGE... Emergency safety drills were last conducted on March 1, 2025 and are completed on a quarterly basis. First aid kit is maintained and contains all the necessary elements. Smoke and carbon monoxide alarms were tested and observed operational. The facility has one (1) fire extinguisher that is fully charged in the kitchen, with a last service date of March 30, 2025. Liability Insurance is effective July 1, 2024 through July 1, 2025. Interviews were conducted with four (4) residents and two (2) staff during today’s visit. Medication and Medication Administration Record (MAR) reviewed. Based on medication and record review, the licensee did not document medication administered to all residents since 6/6/2025. LPA Bentley conducted an audit of five (5) resident files (R1-R5) and three (3) staff files (S1-S3). Resident #1 has an incomplete Physican's Report with primary diagnosis missing from page 2 and date next to Physician's signature. Based on today’s observations, deficiencies are being cited as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. LPA spoke with Administrator Lawrence Lindsey by phone, an exit interview was conducted and a copy of this report, and LIC809-D was provided to Caregiver Connie Martinez.