Routine inspection·March 4, 2025

At approximately 12:30PM Licensing Program Analyst (LPAs) Stevenson and Alviso arrived to conducted an unannounced annual required inspection. LPAs observed a total of two(2) caregivers on duty. Mary Garcia, Licensee/Administrator arrived at approximately 12:40 PM Facility has an approved dementia plan of operation. There is an approved hospice waiver for four (4) residents. Facility has a required infection control plan. Facility has a required emergency disaster plan. Fire clearance is approved for six (6) non-ambulatory, which includes one (1) bedridden, any resident room may be used for the bedridden clearance. Mary Garcia has a current RCFE administrator certificate, #7003093740-expires 6/5/2025. Mary Garcia has a current RN license. At approximately 1:00PM a tour of the facility was performed with licensee Mary Garcia and all knives, and toxins/cleaners were locked up and inaccessible to residents in care. All smoke alarms and the carbon monoxide detectors were checked by the local fire Department in August of 2024, and passed inspection, All smoke alarms and the carbon monoxide detector were tested and observed to be working properly. Fire extinguishers were observed to be charged and tagged as required and are scheduled to be re-inspected in May of 2025. All exits were clear and unobstructed. Hot water was checked at 114.4.F and 110.7F. which is within regulation. Facility was clean and orderly during the inspection. The facility was observed to be at a comfortable temperature and without odors. Food supply was observed to be sufficient, healthy appearing and of good variety. LPAs reviewed medication records, records were complete; All medications were stored appropriately as required. Continued on LIC809C Continued from LIC809 At approximately 2:15PM, LPAs reviewed staff training records. Staff have required annual training, and have required first aid and CPR certifications. All staff have criminal record clearance as required. At approximately 2:40PM LPAs reviewed client files and observed the files to have all required documentation. LPA's discussed with licensee to ensure that the appraisal and needs service plans are review with and signed by pertinent parties. LPA is requesting the following documents be updated and submitted to CCL by 4/04/24. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Infection Control Plan (ensure to review and update as needed/required) Copy of Current Liability Insurance Resident Roster No deficiencies cited in today's inspection.