Routine inspection·June 18, 2025

On June 18, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the Assisted Living Director (ALD), Joni Tsukimura, and disclosed the purpose of the inspection. Executive Director (ED), Preet Kaur joined shortly after. The facility consisted of seven (7) buildings from one to three floors each. There was one (1) building with a combination of Assisted Living unit (Lodge) and Memory support unit (Health Center) and six (6) buildings for Independent living units (Redwood, Cedar, Magnolia, Maple, Birch, and Willow). The ALD informed the LPA that the facility had 172 residents in care at the time, including 31 in Assisted Living, 15 in memory support, and 126 in Independent Living. At 9:50 AM, LPA initiated a walk-through of the facility, accompanied by ALD. LPA inspected randomly selected eight (8) resident rooms in Assisted Living and Memory Care units. The rooms were found to be clean, well-lit, and equipped with the required furniture. Emergency pull cords were observed to be functioning in the resident rooms with an average response time of 1 minute. LPA inspected the private bathrooms in random rooms. The bathrooms contained soap, grab bars, towels, a trash can, and non-slip flooring. The hot water temperature at the sink faucets measured between 110.3°F to 113.6°F. “Oxygen in Use” signs were observed posted outside the residents’ room where oxygen was administered. LPA inspected the Assisted Living and Memory Support kitchen and found it clean. The refrigerator, freezer, and pantry cabinets were checked, and there was a sufficient supply of fresh perishable food for two (2) days and nonperishable staples for seven (7) days. Continued on LIC809-C No expired food items were found. Open food items were wrapped and dated. The dining rooms in Assisted Living and Memory Care were inspected and were found to be clean, with all furniture in good repair. A weekly food menu and menu with alternate food options are available to the residents. LPA inspected activity areas, library, media room, fitness center, arts and crafts room, and living room areas. LPA observed residents watching TV and engaged in recreational programs and activities. Monthly activity calendar was available for the residents. All common areas were free from obstructions, and hallways were well-lit. Evacuation chairs were observed in the stairwells. LPA inspected locked laundry stations in Memory support and Assisted Living and observed washer and dryer units. Sharp objects, detergents, and chemicals were observed to be locked and inaccessible to persons in care. LPA observed locked centrally stored medication carts in the Assisted Living and Memory Support units. Medications were organized separately for each resident. Narcotics were locked. All medication bottles and bubble packs were properly labeled. Centrally Stored Medication Records were reviewed and found to be complete. LPA inspected the first aid kit in the medication room and found it fully stocked. LPA toured the outside courtyard and patio areas and found passageways in good condition, free of obstructions, and without any blocking or tripping hazards. These areas had patio tables, chairs, and umbrellas for residents’ use. Delayed egress was observed on emergency exits. LPA inspected the fire extinguishers mounted on the hallway walls in Assisted Living and Memory Care and found them fully charged, with the last service tag dated 12/09/2024. The fire alarm, smoke detector, and fire sprinkler systems are tested annually by a third-party vendor, Battalion One Fire Protection. A staff member tested the carbon monoxide detector in one of the resident’s in LPA’s presence, and it was found to be functional. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster (Fire and Earthquake) Drills were conducted quarterly, with the most recent drill completed on 04/10/2025. LPA reviewed six (6) staff personnel records and five (5) resident records. The LPA observed that 5 of 5 residents had the Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, Personal Rights, and Consent forms. LPA observed that 6 of 6 staff members had LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 6 of 6 staff members were associated with the facility. Continued on LIC809-C The following updated forms are requested to be submitted to CCLD by 06/25/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Administrator Certificate(s) No deficiencies were cited during today's visit. An exit interview was conducted with the Executive Director. A copy of this report was provided to the Executive Director, Preet Kaur, whose signature on this form confirms receipt of the report.