Routine inspection·October 2, 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 5 residents and the home currently has 5 residents, with 3 residents on hospice. Administrator (AD) Darlene Beason arrived shortly to conduct facility tour. LPA along with AD toured the facility at 10:00 AM. LPA toured the physical plant, checked food service, and facility documentation. The home consists of six resident bedrooms, staff room, living room, dining room, and kitchen as well as seven 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 showers were free of mold/mildew. Water temperature measured between 106.1 degrees F and 118.4 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. Facility conducts quarterly emergency drills with the last drill conducted on 08/16/2025. Outside grounds were toured.There is shaded outdoor seating for residents. Exit gates are unlocked and operational. LPA observed the emergency food and water supply. Continued on LIC809-C dated 10/2/2025 First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise and music therapy. LPA reviewed five resident files and two staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained TB testing and proof of CPR training. Staff 1 (S1) did not have their criminal record clearance transferred to the facility. LPA assisted with the transfer. S1 and Staff 2 (S2) did not have documented evidence of a health screen completed. S1 did not have documented training records fulfilling the required initial 40 hours. S2 has had 16 hours of training documented within the last 12 months. LPA reviewed medication storage and administration. Medications are stored in a locked closet. Medications are being administered per physician order. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Civil penalties for failure to transfer criminal background clearance are being assessed. See LIC421BG. This report was discussed with the facility representative and a copy was provided along with appeal rights.