Routine inspection·December 23, 2025

At approximately 09:00 AM, Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a required 1-year annual inspection and was greeted by LVN caregiver Pam Deleon who has Designation of Facility Responsibility (RP). Administrator Jasmine Aliscad was called and informed of inspection and arrived later at 09:50 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with four (4) residents in care. Two residents were present and one was away with Administrator at an assessment and another resident was away at day program. Facility has a Dementia Care Plan, is approved for all non-ambulatory residents and has a hospice waiver for one (1) and is vendorized with North Bay Regional Center (NBRC). At approximately 9:30 AM, LPA initiated a tour of the facility with RP and observed the following: Facility is a one story home, was a comfortable temperature, free from odors, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene products, incontinent care supplies, 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. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency food and water supply. In addition each resident has a dedicated emergency go-bag. There is a shaded seating area with a electronic retractable awning in the backyard with outdoor space and stainless steel Bar-B-Que for use. In addition, facility has wide wheelchair ramps in front and back of the home. LPA observed 1 locked shed in the backyard which LPA inspected and observed the contents to consist of PPE supplies, extra resident care equipment, holiday decorations, and a large emergency generator. Continued on LIC809-C... Continued from LIC809C... LPA observed an activity schedule and were informed that the residents play bingo, play indoor bowling, watch movies, and engage in sensory activities. Facility also hosts holiday parties for the residents and throws a large Halloween, Thanksgiving, Christmas, and 4th of July party in a central location where all five (5) care homes attend. Facility has internet access and provides a designated internet access device for resident use. Facility has a telephone which was tested during inspection. Facility's fire extinguisher was observed charged and was last serviced 10/2025. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Centralized Fire system was tested and all fire doors closed automatically. Facility conducts monthly disaster drills, and the most recent drill was conducted 12/2025. LPAs observed the facility's infection control plan, first aid kit, PPE, and emergency supplies. LPAs reviewed facility's emergency disaster plan last updated 1/2025. At approximately 10:30 AM, LPA conducted file review. Four (4) staff files and four (4) resident files were reviewed. One (1) staff member hired 10/14/2025 was noted to have evidence of initial 40 hours of training and orientation within the 1st four (4) weeks of hire, but did not have evidence of the full 14 hours of dementia training or the full 8 hours of postural supports/restricted conditions, hospice care training in those 40 hours and a Technical Violation was issued . Four (4) of four (4) resident files reviewed contained all the required documentation per regulation. Administrator states they coordinate residents' medical and dental appointments and transportation to and from visits. Medications and P&I were reviewed and observed managed and maintained within regulation. Updated copies of the following documents were obtained during this visit : LIC500 - Personnel Report (updated) LIC610D Emergency Disaster Plan (updated) Proof of Liability Insurance LIC 9020 Register of Facility Clients/Residents Technical Violation is cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), may result in a civil penalty assessment. Exit interview conducted with Administrator and Appeal rights were given. Signature on form confirms receipt.