Routine inspection·July 25, 2025

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with staff Krystal Boyles-Ambrecht. There are residents with a diagnosis of dementia and residents receiving hospice services. Required postings were observed. LPA/staff initiated a tour of the facility at approximately 9:00 am and observed the following: Facility was a comfortable temperature and passageways were free from obstructions. Facility has a pool that is surrounded by a locked gate to ensure resident safety. Resident rooms were furnished per regulation. Extra linens and hygiene products were available. Water temperature in resident's bathrooms measured at 116.8, 114. 8 and 112.1 degrees F in bathrooms used by residents in care, which are within the range allowed by regulation. LPA/staff observed toilet handle was loose and staff fixed it immediately (technical violation issued). Toxins were inspected and are stored in the locked laundry room. At least two days of perishable and one week of nonperishable food was available. Fire extinguishers were last inspected May, 2025. Smoke alarms throughout the facility and carbon monoxide detector were tested and operational. Last disaster drill conducted on 7/24/2025. At approximate 9:15 am during tour of the facility LPA/staff discovered a monitor outside of bedroom# 3. Additionally, LPA reviewed the facility house agreement and there is no information regarding the use of a monitor. Per staff, resident's responsible party brought the device because they used to monitor resident when they were at their home. Staff removed and discarded the monitor immediately. Continue on LIC809C... Continued from LIC809... LPA initiated file review at 9:30 am. Two staff and four resident files were reviewed. Staff First Aid/CPR Certificates are current, but one out of two staff (S2) needs to complete additional required 20 training hours. Three out of four residents (R1, R2 & R3) care plans needs to be updated. All medical assessments were current. Administrator Certificate for Pamela Johnson 7005563740 expires on 7/27/26. Annual fees are current. At approximately 10:30am a spot check of medication conducted by LPA and medication records revealed that centrally stored medication log has not been maintained by the facility for all residents' (R1, R2, R3 & R4) medications. Also, LPA learned that resident's (R1) prescribed medication: Aspirin 81mg expired 1/2024; Resident's (R2) prescribed medication: Voltaren cream expired 3/28/2025; Resident's (R3) prescribed medication: calcium/D3 600mg expired on 11/2024, joint free glucosamine dietary supplement expired on 3/28/25 and Tylenol 500mg expired on 1/2024. According to staff, the facility started the transition to a computerized system to keep track of medication records to be automatically updated for them, but the program was not working properly, so they went back to use paper documentation for centrally stored medication logs, but they forgot to enter the medication back into the log for these medications. During the visit, staff have entered the medication information into the log. Medications are kept in a locked cabinet in the kitchen. The facility submitted updates for the following documents: LIC500- Personnel Report, LIC308- Designation of Administrative Responsibility and Liability Insurance. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with staff and a copy of this report was printed for the facility.