Routine inspection·July 28, 2025

On July 28, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the Executive Director (ED), Alberto Golia, and disclosed the purpose of the inspection. The facility consisted of one building with Assisted Living units on floors one to three, and Memory Care units on the fourth floor. The ED informed the LPA that the facility had 81 residents in care at the time, including 62 in Assisted Living and 19 in memory care. LPA initiated a walk-through of the facility, accompanied by ED. LPA inspected the main 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. 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. LPA inspected randomly selected ten (10) resident rooms in Assisted Living and Memory Care units. The rooms were found to be clean, well-lit, and equipped with the required furniture. 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 120.6°F and 128.3°F. “No Smoking / Oxygen in Use” signs were observed posted outside the residents’ room where oxygen was administered. Continued to LIC809-C 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 11/6/2024. A staff member tested the carbon monoxide detector in the hallway in LPA’s presence, and it was found to be functional. LPA reviewed the Fire Prevention routine inspection report, conducted on 02/04/2025, by the Department of Public Safety Fire Prevention & Hazardous Materials Certified Unified Program Agency, City of Sunnyvale. The last semi-annual Fire Alarm inspection was completed on 04/15/2025 and quarterly Automatic Sprinkler Systems testing was completed on 04/15/2025. LPA inspected activity areas, theater room, library, lounges, and other commons areas and observed residents actively engaged in recreational programs and activities. All common areas were free from obstructions, and hallways were well-lit. LPA inspected laundry stations on each floor and observed working washer and dryer units. Sharp objects, detergents, and chemicals were observed to be locked and inaccessible to persons in care. The industrial sized washer and dryer units were observed in the laundry room on the first floor. 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 exit doors. No accessible bodies of water or hazards were observed. LPA observed locked centrally stored medication carts in the Assisted Living and Memory Care units. Medications were organized separately for each resident. Narcotics were locked. All medication bottles and bubble packs were properly labeled. At 11:16 AM, Centrally Stored Medication Records were reviewed, and a medication count check was performed. LPA observed that the medication counts for one (1) medication ‘Hydroxyzine HCL F/C 25 MG tablet’ Evening time bubble pack for one (1) resident (R1) was found to be inaccurate. Two (2) extra days of medication was administered to R1 for ‘Hydroxyzine HCL F/C 25 MG tablet’ medication. The medication from this Evening time bubble pack started on 07/02/2025, R1 was out of the facility from 07/08/2025 to 07/16/2025, and then resumed the medication from 07/17/2025. Today is 12:30 PM on 07/28/2025, a total of 17 days of medication should have been administered to R1, but 19 days of medication bubbles were popped up. The Medication Administration Record did not show records of medication administered prior to 7/14/2025. Continued on LIC809-C LPA reviewed six (6) staff personnel records and ten (10) resident records. The LPA observed that 10 of 10 residents had the Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, Consent forms, Safeguard personal property and valuables, and Personal rights 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. LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted monthly, with the most recent drill completed on 07/13/2025. The following updated forms are requested to be submitted to CCLD by 08/04/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Administrator Certificate(s) The deficiencies are being cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plans of Correction were reviewed and developed with the Executive Director. A copy of this report and appeal rights were discussed and provided to the Executive Director, Alberto Golia, whose signature on this form confirms receipt of these documents.