Routine inspection·January 23, 2025

Licensing Program Analyst (LPA) Marcela Yanez & Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Jean Jose. During the visit, LPA observed 4 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 3 restrooms and 6 residents bedrooms. The front yard and backyard were inspected. LPA toured the facility garage, which is being used as a storage area. There was no obstruction to block the walkways. While touring the backyard, LPA's observed several sheds in the backyard. LPA observed a shed in front of the storage shed in the backyard. Both of these sheds were not locked and contained tools and other toxic materials such as; WD-40 and a paint can.(Photographs were taken.) While, touring the side of the home next to the garage/office, LPA observed a gallon of windshield washer fluid and accessible. (Photographs were taken.) LPA's also observed a shovel next to the exit to the front yard, directly next to the garage/office. ADM locked both storage sheds and secured the windshield washer fluid during visit. While touring the home, Licensee arrived to drop off supplies. LPA's advised Licensee regarding some of the clutter around the facility. LPA's advised Licensee that he/she must maintain the facility clean and in good repair. LPA's noted some of the clutter LPA's observed in the laundry room area and in the backyard. Licensee stated he/she is in the process of de-cluttering. Licensee stated he agreed and understood LPA's observation regarding the clutter. Page 1 of 2 Page 2 of 2 Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 108 degrees F in resident bathrooms. Fire extinguisher was serviced November 28, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on December 15, 2024. LPA reviewed facility records for 3 staff and 4 residents. LPA reviewed 4 resident medications and centrally stored medication records. LPA conducted interviews with 1 staff and 3 residents. LPA provided ADM with CDSS Flyer, "Important updates to Dementia Care and Miscellaneous Changes, effective January 1, 2025." A deficiency and technical violation is being cited during today's visit. This report was reviewed with Administrator Jean Jose and a copy of the signed report and appeals rights was provided.