Routine inspection·March 10, 2025

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski met with facility administrator Jayson Caridad and explained the purpose of the visit. LPA Moleski reviewed four resident files (R1-R4) and three staff files (S1-S3). LPA Moleski observed several residents had appraisals and/or needs and services plans which were not updated within the last 12 months. R1's appraisal and their needs and services plan were dated 08/15/2023, when R1 was admitted. R3's appraisal was undated, but appeared to have been completed when the resident was admitted, around 06/01/2023. R4's appraisal was dated 11/29/2022, when the resident was admitted. LPA Moleski observed that S3's first aid/CPR certification expired as of 10/08/24. While speaking with Caridad, LPA Moleski learned that a resident (S5) had died in mid-February 2025. LPA Moleski asked if there was a death report submitted at the time. Caridad said there was not. LPA Moleski asked to review recent emergency disaster drill records. Caridad said drills had not been conducted or documented. LPA Moleski toured the facility with Caridad and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 74 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 108 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguishers, and carbon monoxide/smoke detectors. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed locked cabinets for the storage of medication. LPA Moleski observed locked cabinets for the storage of cleaning solutions and knives. LPA Moleski interviewed two staff members (S1-S2) and two residents (R2, R4). This facility is hereby cited per 22 CCR Sections 87463(a), 87211(a)(1), and 87411(c)(1), and HSC Section 1569.695(c). An exit interview was held with Caridad. Appeal rights and a copy of this report were left with Caridad.