Routine inspection·March 7, 2025

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct an Annual Required 1 Year inspection and met with care staff, MaGrace Manalo and Marilou Barrola, Administrator, Suzette Tawzer was not available to come during the visit, but was available by phone. During today's inspection there were 6 residents living in the home, none receiving Hospice services. LPA initiated a tour of the facility and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. All auditory door alarms were operational, resident rooms have small hand held bells for residents to use to alert staff. Residents rooms were furnished per regulation. Water temperature in bathrooms measured at 116 degrees F which is within the required allowed regulation range of 105 to 120 degrees F. Extra hygiene products and linens were available. Cabinet containing cleaning supplies was locked. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked. Fire extinguisher charged and last serviced March 2024. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational. Two staff files and 5 resident files were reviewed. Staff have required First Aid and CPR certificates, that expire 2/2026. Staff have the required annual training in file, including dementia training. Administrator Certificate for, Suzette Tawzer expired 12/27/2023 but Administrator stated they submitted paperwork to renew the certificate. Facility also has an additional Administrator and facility was asked to submit required paperwork to Community Care Licensing to change and update the name of the administrator. Continued on LIC809C Continued from LIC809 LPA went over facility needing to ensure some areas of the outside deck railings are sanded/painted and with smooth surface and appropriate for resident use. LPA reminded to always ensure flooring is leveled and correct any minor imperfections before they become a hazard. LPA requested paperwork to change Administrator be sent to LPA by 3/13/2025. LPA also requested facility to send an updated LIC200 with corrections that were requested, by 3/13/2025. Licensee/Administrator to submit updates of the following documents by 4/1/2025: LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (If changes) LIC9020 Register of Residents LIC308 Designation of Responsibility Infection Control Plan (If changes) Liability Insurance Copy of current Lease Agreement No citations issued during todays visit.