Routine inspection·July 3, 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 Brigitte Fisk was notified of the visit via telephone and arrived later to assist. There are currently six residents in care, four of which are receiving hospice care at this time. LPA observed residents relaxing in their respective bedrooms or in the facility's common living areas. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with an attached garage, with six private bedrooms, two shared and one en-suite bathrooms. Bedrooms appear clean and sanitary. All four hospice residents are observed to have beds equipped with full-length bed rails. Hospice plans of care reviewed. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are equipped with grab bars and slip mats. Hot water temperature measured at 119F in multiple bathrooms equipped with faucets used for personal grooming. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secured in the locked laundry area. CONTINUED ON FORM LIC809-C CONTINUED FROM LIC809 Fire extinguisher present is charged with up-to-date maintenance tag. Carbon monoxide and smoke detectors were found to be present and operational. The garage is secured and used for the storage of supplies and food. Emergency food and water supplies verified to be present. LPA and facility staff toured the outside of the facility. LPA observed multiple shaded outdoor seating areas with furniture for resident use. The identified route of egress is free of clutter and obstructions. There is one self-latching gate on the side of the premises. There are no bodies of water on the premises. Egress alarms are in use on exit doors, however facility does not utilize locked perimeters or delayed egress. LPA reviewed six resident records which included all necessary components. LPA reviewed resident medication records and prescription orders for all residents with no discrepancies observed. One resident is observed to have been assessed as bedridden upon admission but is currently able to reposition and attends meals and activities in the common living areas. Type B citation issued as the change in condition has not been documented at this time. LPA reviewed staff records for two staff members present during the visit. CPR training, initial and annual training reviewed for 2024 and 2025. Disaster drills are conducted quarterly and documented. Staff members are verified to be background cleared and associated to the licensed location. Based on the observation conducted during the present visit, one type B deficiency is being cited per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights was provided.