Routine inspection·July 17, 2025

On 07/17/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA was greeted by staff member, Lydia Wilkie and explained the the purpose of the visit. LPA also called the Facility Designated Administrator (FDA), Sherry Ahuja and informed her that CCL was present at this time. It was stated by FDA Ahuja that she would be at the facility within 30 minutes. There was one other staff member present at the time of LPA Pascua's arrival, Ryan Mapp. Current census was 5. This facility is licensed to serve 6 residents who are 60 and older. Of the 6 residents, all may be on hospice, 3 may be non-ambulatory and 1 may be bedridden. The bedridden room is cleared by the local fire department for bedroom #5 only. In addition, non-ambulatory residents may reside only in bedrooms #3 and bedroom #4. Ambulatory residents are to reside in bedroom #1 and #2. Bedroom #2 is the only shared bedroom at the time of the fire clearance. LPA reviewed 5 resident files. Based on the file review conducted, it was learned that 5 out 5 resident files did not have a current needs and services plan. 3 out 5 residents did not have an inventory sheet or a pre placement appraisal. LPA reviewed 3 staff files. Based on filed review conducted, it was learned that 3 out 3 staff members do not have current annual training and staff files appears to have documentation from prior facility. The current FDA has an active administrator certificate #7027497740 and expires on 01/30/2026. A tour of the facility was conducted. A tour of the kitchen was conducted. LPA observed a sufficient amount of 2-day perishable and 7 day non-perishable food supply. LPA observed knives and toxins locked and made inaccessible to residents in care. A fire extinguisher was also located in the kitchen and last serviced on 11/22/2023 by Jorgenson Co and is not in compliance at this time. LPA Pascua observed the local Fire Extinguisher company arrived at the time of the visit to service the extinguishers. A tour of the living area, dining area, and other areas intended for resident use was conducted. Furniture was observed to be in good repair and meet resident needs. A tour of 3 bathrooms were conducted. Hot water was taken to ensure compliance within regulation. Grab bars were present and in good repair. A tour a 4 resident bedrooms were conducted. Resident furniture was observed to be in good repair and meet residents needs. 2 additional staff bedrooms was toured. A linen closet was identified and presented a sufficient amount of linens to meet the needs of the residents. Carbon monoxide and smoke alarms were observed and tested to ensure it was in proper working condition. A tour of the garage was conducted. Toxins and other cleaning supplies were identified and made inaccessible to residents in care. A tour of the back yard was conducted with no hazards present. Perimeter fence and exit gates were observed to be in good repair. The following documentation was requested to be submitted to the department: -LIC 308 -LIC 500 -LIC610e -Liability insurance A technical violation was provided for Sections 87506(a) and 87412(a) . Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited today in violation of California Code of Regulations. The Licensee was informed at the time of the visit that failure to complete Plan of Corrections (POC) by the POC date may result in additional civil penalties. An exit interview was conducted and a copy with appeals rights. of this report was provided to the administrator at the end of this visit.