Routine inspection·July 17, 2025

On 07/17/2025 at 9:00 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPA Hughes met with administrator Edna and explained the purpose of the visit. The current census is 5 with 4 facility staff. This facility is a single story building licensed to serve (5) non-ambulatory and (5) ambulatory residents. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility to be free of odor, clean and in good repair. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA's toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 113.4 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety.  The fire extinguisher is located in the kitchen area and was last serviced on 06/07/2025. LPA's observed the facility has a public telephone in the kitchen area and the facility has the required posters posted. Facility thermostat was observed at 73 degrees Fahrenheit. LPA observed toxins located in the hallway closet kept locked and inaccessible to residents. LPA observed sharp knives kept locked in the kitchen and inaccessible to residents. Continuation 809-C LPA checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed 2 out of 5 residents medications and the medication administration record (MAR) was not in compliance with title 22 regulations. LPA observed 2 out 5 residents medication log without proper documentation of the medication being administered for several days. Administrator stated, they forgot to document medication administration, and that the log would be updated today 7/17/2025. The first aid kit was checked and contained the required components. LPA requested resident and staff files for review. LPA's reviewed 5 out of 5 resident files and they were not complete. LPA's reviewed 5 staff files, and it was not in compliance with Title 22 regulations. LPA observed 3 staff files verification of annual training not updated for the current year. Administrator stated that the training would be purchased and completed. LPA reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared. The following documents will be email to LPA by 07/18/2025 end of day 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (3) LIC 610 Current Emergency Disaster Plan (4) Proof of Current Liability Insurance (5) LIC 500 Current Personnel Report As a result of this annual visit, the facility is not in compliance with Title 22 Regulations, and the deficiency can be found on the LIC 809-D page. An exit interview was conducted with Edna and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.