Routine inspection·July 3, 2025

At approximately 9:40 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a required 1-Year visit and met with house manager/caregiver Angelie Dean who called administrator Princess Diana Silverio, who, by phone reported Angelie Dean has designation of facility responsibility and could help to begin the inspection. Administrator Silverio arrived at approximately 10:30 AM. LPA was informed there are four (4) residents in care with two (2) away in day programming and one (1) resident on hospice and another resident was present. Facility is a Residential Care Facility for the Elderly (RCFE) that has vendored residents from North Bay Regional Center (NBRC). Facility has a hospice waiver for three (3), an approved dementia plan and fire clearance for capacity of six (6) residents; five (5) non-ambulatory and one ambulatory. At approximately 10:35 AM, LPA initiated a tour of the facility and observed the following: Facility is a one-story home, was a comfortable temperature, and passageways were free from obstructions. Water temperature in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed client showers with grab bars and non-slip mats as required. LPA observed a supply of clean linens, incontinent care products, and paper products available to clients. Clients' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. Cabinets in communal areas containing cleaning supplies and other items that could pose a risk were observed locked. Staff rooms containing personal medicines and valuables have lockable doors and it was recommended to administrator to switch key locks to keypad door locks to make compliance with locking staff doors easier. Facility is noted to have four (4) massage chairs, large television, board games and books for residents. Continued on 809-C... Continued from LIC 809... Facility has supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days, however Administrator reports that the residents do not eat much of the fresh fruit and vegetables they put out. Facility has a fire extinguisher, which was last inspected July 2024 and is observed to be fully charged and an appointment to be re-inspected is pending. Smoke and Carbon Monoxide detectors were tested and found to operational during inspection. Facility has hardwired alarm bell system. Facility conducts monthly disaster drills, and the most recent drill was conducted July 2025. LPA observed the facility's infection control plan, first aid kit, PPE, other emergency supplies, an emergency water supply. LPA reviewed facility's emergency disaster plan last updated July 2025 At approximately 11:00 AM, five (5) staff files and four (4) resident files were reviewed. All staff files reviewed have the required CPR and First Aid training certificates, as well as all required initial training hours. LPA observed that four (4) of 4 resident files had all the required documentation per regulation. Licensee states facility coordinates the residents' medical and dental appointments as needed and provides transportation to and from these appointments. LPA reviewed residents' P&I records and medications. Medications were centrally stored and locked and a spot check of administration, observed the administration to be accurate. L PA obtained the follow documents for the Community Care Licensing (CCL) file today including: 1)LIC500-staff roster 2)LIC9020-Registration of facility residents 3)LIC610E-Emergency Disaster Plan 4)Updated Liability Insurance (expires 12/04/2025) 5)LIC308-Designation of Facility Responsibility No Deficiencies were cited during today's inspection. Exit interview conducted with Administrator whose signature on this document confirms receipt .