Routine inspection·April 11, 2025

**Due to computer technical issues, a paper 809 and Administrator/Licensee signature is on file** At approximately 09:45 am, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by Licensee/Administrator Manjit "Goldie" Minhas Facility is a Residential Care Facility for the Elderly (RCFE) licensed for 6 residents with five (4) residents in care. Facility has a Hospice waiver for Three (3), with 1 hospice residents currently in care, and is approved for six (6) non-ambulatory residents. At approximately 10:15 am, LPA initiated a tour of the facility with licensee and observed the following: Facility is a one story home with front of the house views of the hills, was a comfortable temperature, and passageways were free from obstructions. Fire extinguishers were last inspected 03/2025 and were observed to be fully charged . Water temperatures measured between 105F and 120F per title 22 Regulations LPAs 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 2-day supply and variety of healthy perishable foods, 7-day supply of non-perishable food, and emergency water supplies. In addition, a variety of snacks and fruits were observed to be set out for residents. Food was found to be stored in a safe manner with open items covered. Continued on 809C Continued from 809... Facility has an emergency whole-house backup battery wall. LPA observed TVs, books, patio with sun and shade Licensee was advised to ensure that tall green grasses were cut to reduce fire hazard as grasses dry out. Disaster drills were last conducted January 2025 At approximately 11:15 AM LPA conducted a review of four (4) staff records. All 4 staff had required criminal clearance, health records and educational training. At approximately 11:45 AM LPA conducted review of four (4) resident records. Most required documentation was in place, except four (4) of four (4) did not have signed Consent for Emergency Medical Treatment (LIC627C) B-Deficiency issued and Plan of Correction (POC) developed with administrator and due by 05/16/2025 At approximately 12:30PM PM LPA and Licensee Minhas conducted a spot check of medication and medication records with records observed centrally stored and locked. A copy of current Facility sketch was obtained today Licensee/Administrator to submit updates of the following documents by 05/16/2025 LIC 500 Personnel Summary Evidence of current liability insurance LIC 308 Designation of facility responsibility. LIC 610 Emergency Disaster Plan - updated (if needed) and signed and dated Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Licensee/Administrator Minhas Manjit and Appeal rights were given.