Routine inspection·February 19, 2025

Unannounced Annual Licensing visit made out to this facility on 02/19/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Brandon Rose, at this time. A brief interview was conducted with the facility designated Administrator at this time. This facility is licensed to serve up to (6) Non Ambulatory residents at any given time. Current census was 6 residents. It was learned that there were (2) residents under the care of hospice at this time. This facility was approved to be able to accept and retain up to (4) residents at any given time. It was learned that there was (1) resident deemed to be bedridden at this time. The facility was approved to be able to accept and retain up to (1) resident deemed to be bedridden at any given time. Tour of this facility was conducted. A tour of the facility kitchen area was conducted. Drawers and cabinets were opened and the items enclosed were reviewed at this time. Drawers housing knives and sharps were observed to be locked and made inaccessible to the residents at this time. Cleaning agents, bleach, and other supplies were observed to be locked and made inaccessible to the residents at this time. A review of the facility food supply was conducted. A review of the facility's 2-day perishable foods and 7-day nonperishable foods was conducted to make sure that there were sufficient quantities on hand at all times. Medication cabinet, located in the kitchen cabinet, was reviewed. Policies and procedures involving handling, dispensing, and documentation of the resident medications were discussed with the facility designated Administrator member at this time. A review of the facility Medication Administration Record and dispensing log was conducted. Medication cabinet was observed to be locked and made inaccessible to the residents at this time. Living room, dining area, and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time and able to meet the needs of the residents. A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the resident restroom was conducted. Hot water temperature was taken to make sure that it measured within the allowed range of 105-120 degrees at all times. Laundry room, located prior to the garage door exit, was toured. Cleaning supplies, detergents, and bleach were observed to be locked and made inaccessible to the residents at this time. Linen closet was reviewed. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the garage area was conducted. It was learned that this area was mainly used as a storage space for facility related items at this time. First aid kits were observed to be present and contained all of the required components at this time. Fire extinguishers were observed to have been annually reviewed on 02/19/2025 from the local fire extinguisher company, Jorgensen Fire, and observed to be in compliance at this time. Administrator certificate for Brandon Rose was observed to have an expiration date of 06/04/2024 with certificate #6031277740. All updated forms and documents have been submitted to renew at this time with certification dated 04/12/2024. A tour of the exterior grounds for this facility was conducted. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (4) facility resident files was conducted and noted on the following LIC 858. A review of (5) facility staff files was conducted and noted on the following LIC 859. This LPA requested that this facility, and its representative, update the following forms and submit them into CCL for review by this LPA: LIC 308, LIC 400, LIC 500, LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were reviewed and a copy was printed and given to the facility designated Administrator at this time. Exit Interview