Routine inspection·April 1, 2025

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 8:40 AM, LPA Tea was greeted and granted entry into the facility by caregiver staff and explained the reason for the visit. Administrators (AD) Scott Messick and Ryan Roche arrived shortly to assist with the visit. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for six. Currently there are six residents, and none on hospice during today's visit. At 8:53 AM, LPA Tea reviewed six resident files and two staff files. Residents’ files and staff files contained all required documentation. Administrator certificates expire on December 1, 2025. LPA Tea along with AD Messick toured the facility at 9:18 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of 5 resident bedrooms, which one is shared, 1 staff room, 2 full bathrooms, living room, dining room, kitchen and attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. 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 F degrees and 114.4 F degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including dressings, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps secured underneath the kitchen sink. LPA also observed toxin substances to be secured and locked and inaccessible to clients underneath the kitchen sink and garage. The fire extinguisher Annual inspection continued on LIC809C in the kitchen is fully charged. The facility’s last fire drill was conducted on March 10, 2025. Kitchen appliances are operational during today's visit. The backyard has a small garden area. LPA observed emergency food and water supply in the garage. LPA toured the outside grounds and there is ample seating with shade and the exit gates on both sides of the house are self-latching and operational. There is a grill, where the resident’s family have barbecues. Facility provides activities daily conducted by an activity’s coordinator. The residents play bingo and trivia, do arts and crafts. The residents go outside from time to time. At the time of the visit, LPA saw residents playing trivia. At 10:06 LPA reviewed medication storage and administration. Medications are stored in a locked closet by the front entryway. Medications are being administered per physician order. LPA interviewed clients regarding their quality of care and spoke to staff present regarding care provided. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with administrators, Scott Messick and Ryan Roche and a copy of this report LIC809, 809-C, LIC858, LIC859, was read and provided to the facility.