Routine inspection·June 27, 2025

Licensing Program Analysts (LPA) Kesha Lewis and LPM Liza King arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA was met by staff and administrator joined 30 minutes later. LPA explained the purpose of the visit to Administrator and staff. LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 3. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. Chemicals and medications noted to be locked to residents in care. LPA also conducted the infection control domain tool. A pool is located at the side of the facility gated and locked. Hot water temperature was measured at 110 F degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. All necessary documents were in place. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point. LPA observed the facility to not have adequate food supply of 7 days non-perishables and 2 days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. LPA observed, fire extinguishers inspected on 04/03/2025 and current, smoke and carbon monoxide detectors, central heating and air in the facility. The first aid kit was found in compliance. LPA reviewed three (3) staff files. Not all staff is fingerprint cleared and associated to the facility and No staff have current First Aid or CPR certifications on file. Facility is not conducting initial and continuing training as required. LPA reviewed three (3) resident facility files, COVID-19 Plan, and survey binder. Not all necessary documents were in place. Exit interview held with staff and copies of reports left at conclusion of visit. one residents were present at the facility during the visit.