Routine inspection·May 9, 2025

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA met with Lorna Smith, Administrator. The facility is a four bedroom, single- story home with an approved fire clearance of six non-ambulatory residents with a hospice waiver for six. The facility currently has a census of one resident in care. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in one of one resident bathrooms, and testing auditory devices on all exits . The hot water temperature measured 105.6 degrees Fahrenheit. The fire extinguishers are charged and were serviced on October 20, 2022. The facility’s last fire drill was conducted on March 22, 2025 . The facility fire alarms and carbon monoxide detectors were not operational and a deficiency was given. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand for one resident. All appliances in the facility are operational. Knives and sharps were secured in a locked cabinet. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. LPA observed the First Aid Kit had all the required elements. Three of four vacant resident rooms did not have the required beds or linens. Chairs, drawers and lamps were observed in all bedrooms and window screens were maintained and rooms were clean. (Continued on LIC 809-C) (Continued on LIC 809) LPA toured the exterior of the facility. Recently the home had solar panels installed and an area was demolished for permitting purposes. There are two exterior self-latching gates. One exterior gate has solar debris and construction material stored for construction but residents and staff have a clear exterior exit on the north side of the house. The one resident socializes and engages in activities with the Administrator's facility, Senior's Retrea,t during the day. Resident has visitors that takes the resident out in the community. Resident was watching the baseball game in their room during the visit and was waiting for family to visit. LPA reviewed three of three staff training and fingerprint records and reviewed one of one resident record. Resident did not have a medical assessment on file and a deficiency was given. LPA interviewed the resident regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on August 16, 2026. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. LPA has requested an informal meeting to discuss the Technical Support Program (TSP). An exit interview was conducted with Lorna Smith, Administrator and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 809-D and Appeal Rights.