Routine inspection·April 21, 2025

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Brian Schott was notified and arrived later to assist with the visit. There are currently six residents in care, one of which is receiving hospice care. LPA observed residents relaxing in the facility's common living areas as well as in their respective bedrooms. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with a detached garage. The facility has one shared bedroom occupied by a couple and four private rooms in addition to one staff room. There are 3.5 bathrooms, 1.5 of which is en-suite to a bedroom. All showers are equipped with grab bars and slip mats. Bedrooms appeared clean and sanitary. There are full rails for postural support in use for three individual residents, however only one of the three was admitted onto hospice. Hospice plan of care reviewed. One type B deficiency issued. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary. Hot water temperature measured at 118F in two of the bathrooms used for personal grooming and toileting care. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items and the medication central storage are stored securely along with most of the cleaning products. There are however multiple cleaning products left unsecured in and around the shared bathroom accessed from the dining room. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Fire extinguishers are charged and mounted, with up-to-date maintenance documented on the attached tags. LPA tested the smoke and carbon monoxide detectors which were found to be operational. The attached garage is inaccessible to residents. LPA and facility staff toured the outside of the facility. LPA observed an shaded outdoor seating area with furniture for resident use. There are self-latching gates on each side of the property. Routes of egress are free of obstruction. There are no bodies of water on the premises. Facility does not utilize locked perimeters or delayed egress. LPA reviewed six resident records which included all necessary components, however two of the admission agreements on file were found to be missing either the administrator's or both the facility and resident representative signatures. Advisory note issued. LPA reviewed resident medication records and prescription orders with no discrepancies observed. Oxygen is currently in use with adequate signs displayed. There are no bedridden residents present on the premises. LPA reviewed staff records for three caregivers in staff. Records were found to be complete. Training and CPR/First aid training reviewed and up-to-date. All staff are background cleared and associated to the licensed location accurately. Disaster drills are conducted quarterly on average. Based on the observations made during today’s visit, two type B deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.