Routine inspection·June 12, 2025

At approximately 10:15AM Licensing Program Analyst (LPA) Contreras arrived unannounced to conduct an required annual inspection and was greeted by administrator(admin) Jennifer Saddi. Facility is a Residential Care Facility for the Elderly with currently 6 residents in care. Facility is approved for 6 residents with a hospice waiver for 3. LPA and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered with expiration dated noted. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 115 degrees F which is within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 2/03/2025 Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Door alarms were operational. Facility’s last quarterly disaster drills were conducted with each staff member during their respective training days. Continued on 809C... Continued from 809.. Entrance to garage is being used for staff room. Staff room not indicated in facility sketch. LPA told admin to submit new facility sketch and fire clearance request for room in garage by 6/19/2025. LPA conducted a review of 6 resident records. All required documentation present. LPA conducted review of 4 staff records. Two staff did not have required Health Screening(LIC503). Admin provided an LIC503 from a previous facility which appeared to be fabricated with the year changed with original year from 2022. LPA did not accept and let admin know LIC503 must be from current facility from date of hire. Both staff did have TB clearance. LPA spoke with admin and advised all staff must have required records in file. S1 did not have TB clearance and Personnel Record(LIC501) present. S2 did not have (LIC501) present. (Deficiency Cited, see LIC809-D) 3 out of 3 staff did not have required 40 initial training hours and required 20 annual hours. LPA spoke with admin about required training and advised admin to immediately have staff properly trained during initial and annual . (Deficiency Cited,see LIC809-D). LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. Jennifer Saddi Administrator Certificate #7004150740 expires 5/23/2026. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Current Lease Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given .