Routine inspection·May 1, 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 6 non-ambulatory residents of which 6 may be bedridden. Facility has an approved hospice waiver for 6 residents and the home currently has 6 residents, with 5 residents on hospice. Administrator (AD) Josephine Teehankee arrived shortly to help conduct facility visit. LPA along with staff toured the facility at 2:35 PM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of 6 resident bedrooms, 2 staff rooms, office, living room, dining room, and kitchen as well as 7 bathrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 107.6 degrees F and 108.3 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Smoke detectors tested 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. Facility conducts quarterly emergency drills with the last drill conducted on 04/05/2025. Outside grounds were toured. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. There is shaded outdoor seating for residents. Exit gates are unlocked and operational . First aid kit contained all required items including tweezers, scissors and thermometer. Continued on LIC809-C Facility conducts activities in the form of exercise and music therapy. LPA reviewed five resident files and two staff files. Four out of five resident files reviewed contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders for bed rails as indicated. One resident file did not include a physician's order for bed rails. One out of two staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. One staff file did not have a medical assessment. LPA reviewed medication storage and administration. Medications are stored in a locked closet. Medications are being administered per physician order. 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.