Routine inspection·April 14, 2025

On 04/14/25 Licensing Program Analyst (LPA) Javina George made and unannounced visit to the facility to conduct a 1 year required inspection. LPA met with Administrator Tyla Kincerlow, where LPA explained the purpose of the visit. During today's visit LPA obtained updated facility contact information, and will update as applicable. The facility is licensed to serve (5) non ambulatory residents of which (1) may be bedridden, with (0) bedridden residents in care at this time. There is also an approved hospice waiver for (4) with (2) residents currently receiving hospice services. LPA conducted a file review and observed for the facility's annual fees that are due by 4/29/25, to not have been paid. LPA provided the following PIN 811329, should the Licensee wish to pay electronically. LPA conducted a records review and observed for the residents to have current medical assessments and admission agreements. Staff present were observed to not have valid Cardio Pulmonary Resuscitation (CPR) certification, deficiency cited . In addition to no initial training for Staff #1 (S1) or updated training for Administrator Tyla Kincherlow. LPA observed for Tyla to not have a valid administrator's certificate, and stated that she is in the process of obtaining her renewal certification. deficiency cited . The laundry appliances were observed to be operable. The facility food supply was observed to be sufficient as there was a (2) day supply of perishable and a (7) day supply of non perishable food items. LPA observed for there to be medication stored inside the refrigerator on the side door. There is no valid Liability insurance insurance, and the facility is not conducting emergency disaster drills on a quarterly basis as required, in addition the fire extinguisher has not been serviced since 2/12/2020, deficiencies cited. Based on today's inspection a citation will be issued on the attached 809D, in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). LPA provided Tyla with the LIC311F-Records to be Maintained at the facility, and requested the following: Please submit to the licensing office the following forms 5pm 4/28/25: Current Designation of Administrative Responsibility (LIC 308) Personnel Report (LIC 500) Emergency Disaster Plan LIC610-E Remove the cameras in the common areas ***Forms are available at www.ccld.ca.gov An exit interview was conducted and a copy of this report, 809D, appeal rights, LIC811-Confidential names List, LIC9098-Proof of Corrections form was reviewed and provided to Tyla Kincherlow.