Routine inspection·September 5, 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 5 may be bedridden. Facility has an approved hospice waiver for 6 residents and the home currently has 6 residents, with 1 resident on hospice. Administrator (AD) Alexandra Bryant assisted with facility tour. AD provided updated liability insurance that expires on 02/20/2026. LPA along with AD toured the facility at 8:45 AM. LPA toured the physical plant, checked food service, and facility documentation. The 2 story home consists of 6 resident bedrooms on the first floor, 3 staff rooms in the second floor, living room, dining room, and kitchen as well as 6 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 111.5 degrees F and 112.8 degrees F in all bathrooms checked. 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 06/01/2025. Outside grounds were toured. Walkways around the home were clear of hazards. There is shaded outdoor seating for residents. Exit gates are unlocked and operational. Continued on LIC809-C dated 09/05/2025 First aid kit contained all required items including tweezers, scissors and thermometer. LPA observed the emergency food and water supply. LPA reviewed six resident files and two staff files. Five out of six resident files contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders for bed rails as indicated. 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. Medication for resident 6 (R6) is not being administered as prescribed by the physician. Based on the observations made during today’s visit, a deficiency is 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.