Routine inspection·September 22, 2025

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's required - 1 year inspection. LPA met with Administrator/Licensee, Dina Clark. During visit, LPA toured the facility to include the living room, kitchen, resident bedrooms, bathrooms, garage, and exterior. All fire exit routes were free and clear of obstruction. There was 1 staff to 3 residents. Facility staff present are fingerprint cleared and associated to the facility. As of today, there are no residents under hospice care. Facility temperature maintained at 77 degrees F. Kitchen supplied with at least 2 days worth of perishables and 7 days worth of non-perishable foods. LPA observed the facility has fresh fruits on the kitchen counter to include bananas, oranges, apples, cantaloupe, and watermelon. Refrigerator temperature maintained at 40 degrees F. Freezer temperature maintained at 0 degrees F . Sharp object, chemicals and disinfectants are locked and stored separately from the food supply. Lidded trash bin observed in the kitchen. At 2:15PM, the hot water temperature in the bathrooms were measured at 101.8 - 102 degrees F. During visit, licensee adjusted the hot water temperature. At 02:57PM, the hot water temperature in the bathrooms was measured at 105.8 degrees F. Resident bathroom equipped with a shower chair, grab bars, and non-slip mats. Resident bedrooms equipped with beds, linens, dresser, night stands, and adequate lighting. Sliding doors equipped with door alarms and observed clear of obstruction. SEE LIC809-C. LPA reviewed 3 resident files contained an admission agreement, medical assessment, TB result, personal rights, consent forms, and updated and signed appraisal/needs and services plan. The appraisal/needs and services plan were observed signed and completed. LPA reviewed 3 staff files were reviewed and observed complete. 3 out of 3 staff has an active 1st aid certification, health screening, TB result, and personnel record. Staff are provided at least 20 hours of annual training to include topics of emergency preparedness, dementia/Alzheimer's, medications, and oxygen use. ADM states training is ongoing throughout the year. ADM states a plan to complete training on postural supports and restricted health conditions. LPA observed the facility's prepared emergency supply which includes linens, non-perishable foods, emergency lighting, and a first aid kit. Facility has flashlights, lanterns, and batteries in case of an emergency. Fire extinguisher last serviced on 10/07/2024. Carbon monoxide present and observed operable. Facility has a large plastic bin filled with PPE supplies in the garage. Licensee states the last emergency drill was completed on 07/07/2025, but Licensee was unable to find the document of the drill which includes the topics of the emergency covered, participants, and date of the drill. Licensee states on 07/07/2025 she remembers covering the topic of fire and fire failures. Licensee states to have remembered covering the emergency drills in January, March and July 2025 which are the same dates listed on the LIC610E, however thinks the document of the drills was either left in her other care facility or at home. Licensee will find the emergency drills documents and submit the documents to LPA Kabariti via email. A technical violation was provided. Posters observed in the hallways to include but not limited to complaint poster, ombudsman poster, emergency disaster plan, facility license, personal rights, and COVID-19 related resources. The following documents were obtained during visit to update the facility file: LIC500, liability insurance, and page 9 of the LIC610E. No deficiencies were cited per California Code of Regulations, Title 22. Technical advisory was provided. This report was reviewed with Administrator/Licensee, Dina Clark and a copy of the report was provided.