Routine inspection·August 5, 2025

At approximately 12:25 PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a required 1-year annual inspection and was greeted by Administrator Patricia Harland. Facility is a Residential Care Facility for the Elderly (RCFE) with three (3) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for three (3), with one (1) Hospice resident currently in care, and is approved for all non-ambulatory residents. At approximately 12:45 PM, LPA initiated a tour of the facility with Administrator and observed the following: Facility is a two (2) story home, was a comfortable temperature, and passageways were free from obstructions. Facilities second story is used solely by staff and is not accessible for residents. Fire extinguishers were last inspected 12/24. Smoke and Carbon Monoxide detectors are hardwired and serviced by the Fire Marshall, last inspection was 12/24. Water temperature measured 107.2 degrees F and 109.4 degrees F, which is within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. There is a shaded seating area in the backyard with outdoor space for activities. Facility has an internet access devise and internet available to clients in care, and the phone was tested and operational during today's inspection. Continued LIC809C... Continued from LIC809... Facility conducts quarterly disaster drills, and the most recent drill was conducted 6/25. LPA observed facility's infection control plan and emergency disaster plan which was last updated 7/25. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. At approximately 1:20 PM LPA conducted a review of three (3) resident records. All required documentation present. At approximately 1:40 PM LPA conducted review of one (1) staff records. All required documentation present. At approximately 2:00 PM LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored and locked. Patricia Harland Administrator Certificate 7003252740 expires 1/8/2026. All fees are current as of this time. Updated copies of the following documents were gathered during this visit : LIC610E: Emergency Disaster Plan Liability Insurance Updated copies of the following documents shall be submitted to CCL within 30 days of this visit : LIC500 - Personnel Report LIC308 - Designation of Responsibility LIC400 - Affidavit Regarding Client Cash Resources No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.