Routine inspection·July 22, 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. Facility has an approved hospice waiver for 6 residents and the home currently has 3 residents, with 1 resident on hospice. Administrator (AD) Sheryl Tongol arrived shortly to assist with the visit. LPA along with staff toured the facility at 8:45 AM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of 6 resident bedrooms, living room, dining room, and kitchen as well as 4 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 at 116.7 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarm in room 5 was not 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. At 8:50 AM, LPA observed Clorox wipes unsecured on the bathroom counter top. 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 03/20/2025. Outside grounds were toured. There is shaded outdoor seating for residents. Exit gate is unlocked and operational. At 9:15 AM, LPA observed sharps including hedge shears and a bolt cutter unsecured on the ground next to the garage entrance through the backyard. Continued on LIC809-C dated 07/22/2025 First aid kit contained all required items including tweezers, scissors and thermometer. LPA reviewed three resident files and two staff files. All resident files contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders for bed rails as indicated. 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. LPA reviewed medication storage and administration. Medications are stored in a locked closet. 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.