Post-licensing visit·May 6, 2025

At approximately 9:50 AM, Licensing Program Analyst (LPA) Elias Magdaleno arrived unannounced to conduct a post-licensing visit and was greeted by Caregiver. Jean Rice, Administrator arrived shortly after. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), with one (1) Hospice residents currently in care, and is approved for all non-ambulatory residents. At approximately 10:15 AM LPA and Administrator toured the building and grounds which were found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food, as well as an emergency water supply. Food was found to be stored in a safe manner with open items covered. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Water temperature measured 108.5 degrees F, which is within title 22 regulations of 105 and 120 degrees F at faucets accessible to residents. Fire extinguishers were last inspected 6/24. There was enough lighting in all common areas, resident rooms, and hallways. Facility has an internet access device designated for resident use and internet service available. Facility telephone was tested and operational during inspection. There is a shaded seating area in the backyard with outdoor space for activities. LPA observed one (1) locked shed in backyard which is used as a staff room. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. Emergency disaster plan last updated 7/2024. Continued 809C... At approximately 11:00 AM LPA conducted a review of two (2) resident records. All required documentation present. At approximately 11:20 AM LPA conducted review of two (2) staff records. All required documentation present. Medication is centrally stored and locked. Jean Rice Administrator Certificate 7006023740 expires 10/1/2026. All fees are current as of this time. Updated copies of the following documents were collected this visit : LIC308 - Designation of Responsibility Admission Agreement LIC500 - Personnel Report LIC610D - Emergency Disaster Plan Updated copies of the following documents shall be submitted to CCL within 30 days of this visit : Control of Property Job Descriptions/Personnel Policies Theft and Loss policy Transportation Policy No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.