Routine inspection·August 14, 2025

On 8/14/2025, Licensing Program Analysts, Ellen "Triel" Lindstrom and Arvin Villanueva (LPAs) arrived unannounced at this facility to conduct their annual inspection visit. LPA met with staff on duty (S3) and stated the purpose of the visit. The Administrator on record Raymond Gin (S1) was notified and informed LPAs that the Co-Administrator Shiela Seaberg (S2) will assist with the annual because Raymond is currently unavailable. S2 arrived shortly after. Overview : Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 non-ambulatory elderly residents. Facility has a hospice waiver for 2 residents. Initial Observation: Upon arrival LPAs were greeted by staff on duty (S3). Present during this visit were 6 residents in care with one staff on duty. LPA observed required posters and facility license at the entrance. Room temperature was at 78 degrees Fahrenheit upon arrival. Physical Inspection : Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPAs inspected 3 of 5 resident bedrooms. LPAs observed 2 of 3 resident bathrooms. LPAs measured the hot water temperature in the 1 of 3 bathrooms to be at 111 degrees Fahrenheit. Fire extinguisher was observed in the kitchen area and was last inspected on 5/13/2025. Smoke and carbon monoxide detectors were observed throughout. {Con't to 809-C} {Con't from 809} Medication cabinet was inspected. Kitchen area and pantry were observed. Kitchen refrigerator and freezer were inspected. Laundry room and garage area were also inspected. The door to the laundry was unlocked during this visit. The laundry room leads to the garage. The door to the garage was observed to be unlocked. The door to the garage can be unlocked from the inside. Outdoor area was inspected including fence, gates, ramps and emergency walkways. Record Reviews: Review of 3 of 3 resident files (R1, R2, R3) was conducted, include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. Medication review of 2 residents (R1, R3) include review of physician orders for over-the-counter medications. Review of 3 staff files (S3, S4, S5) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. No issues were noted. LPAs also reviewed fire drill/disaster drill records; facility conducts quarterly drills. LPAs was requested a copy of current Liability Insurance Certificate, LIC500 and LIC308 to be submitted to the Department. Advisories were provided: Update residents medical assessments. Per resident record review, R3 did not have updated medical assessment available for review. Obtain PRN Authorization Letter from residents' physician. 3 of 3 residents did not have PRN Authorization on file to determine whether residents are able to communicate their needs for PRN medication. Advisory was provided to develop Infection Control Plan and submit to the Department. Deficiencies were observed: Medication (M1) belonging to R3 was observed inside the bathroom cabinet in bedroom #4. This medication was placed in an unlocked cabinet accessible to residents in care. Per record review, R3 is unable to manage own medication. Medication cabinet was observed to be unlocked and accessible to residents upon arrival. Garage houses a refrigerator. Inside this refrigerator, LPAs observed medication (M2) belonging to R1 inside the refrigerator. Also inside the garage, LPAs observed paint containers on the floor accessible to residents in care. Inside the laundry room, LPAs observed a laundry detergent inside an unlocked cabinet. One of the exit gates did not have a self-latching lock. Per review of the facility sketch, this gate is an emergency exit. Record reviews and interviews revealed that facility do not document PRN medication administration. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were cited. Exit interview was conducted with S1. A copy of the report was provided upon exit.