Routine inspection·July 22, 2025

At 08:30am, on 07/22/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Backup Administrator Nellie Corrales and via phone Licensee/Administrator Evelyn Strampe, announced who he was and the reason for the visit. Prior to today's visit on 7/21/2025 at around 4:44pm LPA researched the standing of the licensee BAYSIDE HOME ENTERPRISES, LLC on California's Secretary of State website and found the status to be "suspended-FTB" as of 6/2/2025. Additionally, LPA noted designated Administrator Evelyn Strampe's administrator certification to not be current on Community Care Licensing Administrator Bureau's website. During visit, Backup Administrator and LPA conducted a full tour of the facility. This facility has four resident bedrooms (two are dual occupancy), two full bathrooms (one is on-suite to the primary bedroom and one is for public use). LPA interview with backup administrator revealed staff are entering the primary bedroom to access the on-suite bathroom for personal use and the primary bedroom is occupied by a resident. There is a living room, a kitchen and dining area. Access to the laundry room and garage is through a locked door for resident safety. While touring the kitchen and dining area LPA noted fresh fruit and snacks in the kitchen for residents to enjoy freely. At 9:09am when touring the kitchen LPA noted more than 10 canned and boxed food items to be 5 months to 4 years past the dated shelf life. LPA noted flying insects on apples placed on the table for residents to eat, one of the three apples had a rotting spot. (Continued on LIC809-C) At 9:15am LPA observed and photographed over twenty bottles and packages of prescription and non-prescription medications belonging to staff in various unlocked cabinets of the dining area and a steak knife in an unlocked kitchen drawer accessible to residents in care. LPA noted that the backyard and the front yard both have seating and shade for residents and visitors. At 9:23am in the backyard LPA observed and photographed a pocket knife sitting on a dresser, and unlocked in the dresser a bottle of rooting powder, wood stain, a metal dagger, lighter, and two pruning shears. All of these items were accessible to residents in care. The facility has wired smoke detectors in each room that are all working, the carbon monoxide detector is in the hallway and functioning normally. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, purchased on 07/22/2025. LPA tested facility hot water at 110.7*(f), within regulation temperatures 105*-120* (f). LPA observed at least 2 - days of perishable and at least 7 - days of nonperishable foods. LPA noted that the facility has no obstructions in hallways, doorways or exits. Staff and client files and medications are locked in a cabinet in the kitchen area. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding incomplete records for all three residents in care. LPA conducted a staff and resident file review. Resident file review revealed all three residents in care do not have a reappraisal completed in the last 12-months. Facility record review also revealed the facility has an incomplete emergency and disaster plan and quarterly emergency drills have not been completed. LPA interview with backup administrator revealed Resident #1 (R1) depends on others for all activities of daily living, a prohibited health condition at this type of licensed facility. Backup administrator stated R1 also cannot reposition in bed independently. Interview also revealed staff transfer R1 to a wheelchair and use a seat belt to keep R1 from falling out of the wheelchair. Backup Administrator states R1 is not capable of releasing the seat belt on their own. Record review of R1's file reveals there is no physician order for the seat belt and an exception has not been granted by Licensing for R1's use of a seat belt. Record review also revealed the facility in not cleared for a bedridden room. (Continued on LIC809-C) LPA and backup administrator conducted a review of the annual care tool modules. Exit interview, deficiencies cited on 809-D pages, a civil penalty in the amount of $500 for fire clearance violation is being assessed on the attached LIC 421IM, report, and appeal rights given.