Routine inspection·July 24, 2025

On 07/24/2025, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA met with Assisted Living Waiver Program Director Leslie Padilla and explained the purpose of the visit. Administrator Caleb Summerhays was not present during today’s visit. The administrator holds certificate number 7026521740 and will expire on 11/17/2025. The facility is licensed for 121 non-ambulatory residents. There are currently 111 residents who reside at this facility. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room, resident lounge 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 toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. LPA measured the hot water temperature in three residents’ bathroom sink and all three water was measured within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mats 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 throughout the facility in each resident’s hall. LPA observed the facility has a has a public telephone stationed by the kitchen for residents use and the facility has the required posters posted. Continued LIC 809-C The facility thermostat was observed at 72 degrees Fahrenheit. LPA observed toxins located in the maintenance and housekeepers’ room and kept locked and inaccessible to residents. LPA observed sharp knives kept locked in the kitchen drawers and inaccessible to residents. LPA checked medication storage and found medication to be locked away and inaccessible to residents. The LPA reviewed six residents’ medications on hand along with their Medication Administration Records (MARs) and found them to be complete. However, at 1:02 PM, LPA observed a Med-Tech pre-pouring residents’ medications for the afternoon medication pass. During an interview, Med-Tech stated that medications are scheduled to be administered at 2:00 PM. The facility’s first aid kit was inspected and found to contain all required components. Additionally, the LPA tested five residents’ call lights, and staff responded appropriately during the visit. LPA requested resident and staff files for review. A total of nine resident files were reviewed and found to be complete. Of the six staff files reviewed, four were incomplete. Staff 1 (S1) is missing their TB test and First Aid certificate. (S2) is missing their health screening results and 20 hours of continuing education training. (S3) is missing their 20 hours of continuing education training. (S4) is missing their First Aid certificate. The following documents will be email to LPA by 07/29/2025 at the end of day 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. An exit interview was conducted with Leslie and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.