Routine inspection·June 26, 2025

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Licensee David Cooper. The facility's license shows a maximum capacity of fifteen (15) non-ambulatory residents, of which seven (7) may be bedridden. Hospice waiver approved for fifteen (15) residents and the facility is approved for a locked perimeter. During today’s inspection, there were twelve (12) residents in care. LPA accompanied by Licensee Cooper toured the interior and exterior of the facility and inspected each room. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. The pool located on the premises was fenced and locked. Per Licensee Cooper, no firearms or ammunition are kept at the facility. Carbon monoxide detectors and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [Continued on LIC809-C] LPA reviewed facility records. During review of staff records LPA observed that Staff #1-3 (S1-S3) did not have a health screening report in the files. One deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). A plan of correction was jointly formulated, and an exit interview was conducted with Licensee Cooper, to whom a copy of this report, LIC809-C, LIC809-D and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.