Routine inspection·March 28, 2025

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted by, identified themselves to and discussed the purpose of the visit with Administrator Josefina Hulsey. The facility's license shows a maximum capacity of six (6) residents, of which four (4) may be non-ambulatory and two (2) may be bedridden. During today’s inspection, there were a total of three (3) residents in care. LPA with Administrator Hulsey 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, 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. LPA observed expired canned goods in the pantry. 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. No pools or bodies of water exist on the premises. Per Administrator Administrator Hulsey, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, 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. Administrator Hulsey could not provide proof of conducted quarterly emergency drills, as required. Confidential records were stored in locked areas. For one (1) of the three (3) resident records reviewed the Licensee did not possess a written Needs and Services Plan or equivalent care plan for the client which had been updated within the last year, as required. Two (2) deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D pages) and one (1) deficiency was cited per California Health and Safety Code. Plans of Correction were jointly developed with Administrator Hulsey. An exit interview was conducted with Administrator Hulsey, to whom a copy of this report, the LIC 809-D pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided for today’s visit.