Routine inspection (multi-day)·July 21, 2025

Licensing Program Analyst (LPA), Alviso, conducted a Required - 1 Year Inspection, on 7/21/25, and met with Administrator David Hanna, and Resident Care Coordinator (RCC) Karrie Hanna. Currently twenty-one (21) residents in care; There are two (2) residents are on Hospice. Hospice care waiver approved for eight (8) residents. Facility has a required infection control plan. Facility has a required emergency disaster plan. LPA reviewed seven (7) resident files. All files were complete. LPA reviewed five (5) staff files. All staff have required criminal record clearance. Per file reviews, staff have first aid certification and CPR certification. Staff have required training. LPA toured the facility. There was a sufficient supply of cleaners/disinfectants, paper products, linens, and hygiene products. Facility had a sufficient supply of food. LPA observed residents' having their noon/lunch meal during the inspection. The facility bathrooms had grab bars for resident use, including non-slip/textured flooring in showers for residents use as needed. There was sufficient lighting in the facility, in common areas, bathrooms, and resident rooms checked, for residents use. Fire extinguishers were fully charged, serviced, and tagged as required. Continued on LIC809C... Facility was observed to be clean and orderly during the inspection. All smoke alarms were in all required rooms, and facility has carbon monoxide detectors. All bathrooms had soap supply for use, and had paper towels available for residents' use. All medications were locked up and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents' in care. Outside facility grounds were clean, pathways free and clear of obstruction, and there was outside furniture for residents' use. LPA is requesting the following documents be updated and submitted by 8/21/25: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610-Emergency Disaster Plan (9 pages)- if any updates submit a copy- If no changes, submit copy of last page (signed/dated) Copy of Current Liability Insurance Infection Control Plan- if any updates submit a copy- If no changes, submit copy of last page (signed/dated) Poster of Residents Copy of current Administrator Certificate There were no deficiencies cited during today's inspection. Exit interview was conducted with Administrator David Hanna.