Routine inspection (multi-day)·March 24, 2026

On 3/24/26 LPA returned to this facility at approximately 9:30am to complete annual inspection. Previously, on 3/20/25 Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by designee. Facility currently has five (5) residents in care one (1)vof which are currently on hospice. Upon arrival, LPA observed caregiver (S1) present and working in facility but not listed on Guardian roster printed 3/19/26. During LPA inspection of physical plant S1 left the facility. Designee provided LPA with S1's personal information including birthday, driver's license, and last name, but this person turned out not to be the person that was actually present. Person actually present was staff (S2). S2 name and birthday given to LPA. Per designee, S2 does not have fingerprint clearance but has been working for about 2 weeks at facility. LPA advised S2 cannot return to facility until S2 has fingerprint clearance ( deficiency cited, see 809D and civil penalty assessed in the amount of $100 per day for 5 days for a total of $500, see LIC421BG ). Licensee is aware that S2 did not have fingerprint clearance as she is the one responsible for hiring staff and associating staff to facility, not designee. At approximately 2:40pm LPA 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. Box containing 150 eggs left outside of refrigeration inside garage, temperature today was 96 degrees F outside ( deficiency cited, see 809D ) LPA observed refrigerator in garage to be storing food but was not cool, no thermostat so no temperature reading available but refrigerator was also leaking water out form the bottom. Garage has two [2] refrigerators and one freezer. Per designee, the other refrigerator has also been leaking and licensee is aware ( deficiency cited, see 809D ). Light is broken on Continued on 809C... Continued from 809... refrigerator in kitchen. Tile around kitchen sink is in disrepair and showing areas of black and gray substance. Additionally, on 3/24/26 at approximately 2pm LPA spoke with visiting repair individual (I1) from HCB construction. I1 reported to LPA that sink has been leaking for quite some time. I1 reported to LPA that they observed under kitchen sink mold all over: plywood that has mold and has rotted, sides of the cabinet have mold, garbage disposal is covered with rust, and water lines are also covered with rust ( deficiency cited, see 809D ). Cleaning products and laundry soaps are inaccessible to residents in care. 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 grab bars but private bath in room #1 did not have mat. Water temperature in sinks measured at 109.2 degrees F in the kitchen and 109.3 degrees F in the bathroom used by residents, both of which are within the allowable range of 105 to 120 degrees F. Facility has another bathroom used by staff only. Fire extinguishers were last inspected 1/14/25, but showing as fully charged. Smoke/Carbon Monoxide detectors tested and operational. During inspection of physical plant LPA observed medication cabinet to be open and unlocked ( deficiency cited, see 809D ). Additionally, LPA observed medications and supplements in staff room, however, room was locked. LPA advised it could be a good practice to keep all prescription medications if not locked, then secured in a drawer or something in the event that the staff room is accidentally left unlocked. Fireplace in dining area needs a screen. LPA spoke to resident (R1) who informed LPA that staff make all the residents go to their rooms between the hours of 1pm and 3pm. R1 informed LPA that they wanted to go outside but was told they had to stay in their room. LPA immediately informed staff that residents have personal rights, one of which is to have to make choices concerning their daily life in the facility ( deficiency cited, see 809D ). LPA observed residents lying in bed staring at the wall or ceiling. LPA advised designee residents need to have activities to participate in and have cognitive stimulation that meets their needs. LPA did not observe residents engaged in any activities for the duration of both LPA's visits ( deficiency cited, see 809D ). Additionally, R2's hospice care plan dated 3/6/26 on page 6 of 9 social worker indicates adding a TV to their room for additional diversion. Continued on 809C(2)... Continued form 809C... Per designee, they were not aware of the social worker's suggestion. While LPA present, caregivers added a television to R2's room and adjusted their bed so as to have a good view. On 3/24/26, LPA began resident file review at approximately 9:45am. LPA reviewed five [5] out of five [5] resident files. LPA observed full rails on bed for residents (R1 and R2). R2 is on hospice but R1 is not ( deficiency cited, see 809D) . Per designee they will remove full rails rather than request an exception. LPA began staff file review at approximately 11:00am. S3, S4, and S5 do not have restricted conditions training on file and S6 does not have any training at all on file ( deficiency cited, see 809D ). S3 and S4 need 8 hours of in-service medication training completed each year ( deficiency cited, see 809D ). S5 and S6 need a total of 10 hours of initial medication training ( deficiency cited, see 809D ). S5 did have some medication testing documented but no hours of duration noted on documentation. Training completed by a vendor. Vendor not on the approved vendor list. LPA will forward to licensee approved vendor list. Additionally, S6 did not have a health screen or TB clearance on file ( deficiency cited, see 809D ). At approximately 1:45pm LPA and designee did a spot check of medication and medication records. Medication is centrally stored in cabinet. Facility has mini-refrigerator for medication needing refrigeration. R1 had prescription for Doxycycline Monohydrate 100mg, that was not listed on the Centrally Stored Medication Log (CSML) and R3 did not have a CSML ( deficiency cited, see 809D ). 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 Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. 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 House Manager and a copy of this report was given.