Routine inspection (multi-day)·June 6, 2025

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced continuation of the Required 1 Year visit from 5/30/2025. LPA Rai met with Executive Director, Bradley Burgoyne and stated the purpose of today's visit. During visit, LPA Rai toured the inside and outside of the facility. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the facility to include 5 resident rooms, dining room, activity room, kitchen and memory care unit. 5 Out of 5 resident bedrooms had available bedding, drawers, and functioning lights.  The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom sinks ranged from 111.6 - 113.7 degrees F. LPA Rai observed 1 prescription medication located in the bathroom mirror cabinet wall mounted above the sink in Resident R5's Room. Staff (S1) stated the medication should not be present in R5's room and R5's medications should be locked and inaccessible to resident. Based on review of R1's LIC 602A Physician's Report 3/6/2025, R1 has neurocognitive disorder and R1 is not able to administer own prescription medications, and not able to store own medications. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. Facility smoke detectors, sprinkler system and delayed egress doors were inspected by a third party vendor on 10/15/2024. The last disaster drills were conducted on 2/28/2025 and 3/5/2025. LPA Rai reviewed resident medications and central stored medication records. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. LPA Rai informed Executive Director, Bradley Burgoyne about the Department’s Technical Support Program (TSP) and provided the website: Community Care Licensing Division (CCLD) website www.cdss.ca.gov . LPA Rai requested an updated LIC 500 to update the information on the current Administrator as Bradley Burgoyne. Executive Director agreed and understood. This report was reviewed with Executive Director, Bradley Burgoyne. A copy of the report was provided. Appeal Rights were provided.