Routine inspection·June 30, 2025

Unannounced annual visit made out to this facility on 06/30/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility Business Office Manager, Jennie Tello, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator, Kathryn Nevin, to inform her that CCL was present at this time for an annual visit. It was learned that this facility currently has (3) residents under the care of hospice at this time. This facility does have an approved hospice waiver to be able to accept and retain up to (3) hospice residents at any given time. It was learned that there were 37 residents diagnosed with dementia at this time. It was learned that there were (4) residents receiving services through a home health agency at this time. It was learned that there was (1) resident deemed to be bedridden but was currently under the care of hospice at this time. Current census was 89 residents. Tour of the facility was conducted. Living area, dining area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient, in good repair, and able to meet the needs of the residents at this time. Kitchen area was toured. Cabinets and drawers were opened and the contents were reviewed at this time. Items for preparing, cooking, and serving meals unto the residents were observed to be sufficient and in compliance at this time. Cleaners and cleaning agents were observed to be locked and made inaccessible to the residents at this time. Fire extinguishers, located hanging on the walls throughout this facility, were observed to have been annually inspected on 09/26/2024 by the local fire extinguisher company, Sentinel Fire Equipment Co., and was in compliance at this time. Medication room was observed to be locked and made inaccessible to the residents at this time. An interview was conducted with the facility medication technician and a brief review of the narcotics count log was conducted at this time. First aid kits were observed to be present and contained all of the required components at this time. Food supply, and food storage units, were observed to be sufficient and able to meet the needs of the residents at this time. This facility was observed to have, on hand at all times, a sufficient supply of 2-day perishable and 7-day nonperishable food quantities at this time. A tour of the facility bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the facility restrooms was conducted. Grab bars, non skid mats, and toiletries were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees at this time. A review of the laundry room was conducted. Bleach, detergent, and all other laundry supplies were observed to be locked and made inaccessible to the residents at this time. Exterior grounds of this facility were toured. Facility perimeter fence, side gates, and all other exits were reviewed at this time. Administrator certificate for the facility designated Administrator, Kathryn Nevin, was observed to be present with certificate number 6077502740 and set to expire on 05/26/2027. A review of (5) facility personnel files was conducted and noted on the following LIC 859. A review of (5) facility resident files was conducted and noted on the following LIC 858. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interview