Routine inspection·June 3, 2025

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Licensee Josephine Credo. At approximately 1:45pm 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. Food was found to be stored in a safe manner with open items covered and most were labeled. Kitchen cabinet containing cleaning supplies was locked. Kitchen drawer with sharp knives locked. 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 bathroom had required bath mat and grab bar. Water temperature in sink accessible to residents in care measured at 109.7 degrees F which is within the allowable range of 105 to 120 degrees F. Residents in rooms #3 and #6 have oxygen in use but licensee could not produce notification fax to fire dept ( deficiency cited, see 809D ). Additionally, rooms #3 and #6 do not have oxygen in use sign present ( deficiency cited, see 809D ). Fire extinguishers were last inspected 2/14/25. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills were conducted last conducted 4/19/24 ( deficiency cited, see 809D ). Facility has a backup generator for use during a power outage. At approximately 3:30pm LPA conducted a review of 6 resident records. Residents R1 and R2 have Continued on 809C... Continued from 809... Appraisal Needs and Services plans dated 5/31/22 and 6/13/22, respectively ( deficiency cited, see 809D ). This deficiency was cited at facility's last annual inspection and re-cited for failure to correct on 7/19/24. However due to regulation changes, the regulation is now 87463(a), it is no longer 87463(c), so LPA unable to assess civil penalty for repeat violation At approximately 2:30pm LPA conducted review of four [4] staff records. S1 is not associated to the facility nor do they have fingerprint clearance. LPA verified fingerprint status on Guardian website. S1 has entry on Guardian with a determination status of closed incomplete application, closed on 12/2/24 with a status date of 3/2/25. LPA printed letter sent to applicant for licensee ( deficiency cited, see 809D and civil penalty assessed. ) Additionally, per licensee and S1, S1 had just moved their belongings into the trailer on the side of the facility. LPA advised that S1 cannot reside in trailer until fingerprint clearance granted. Staff S1 and S3 did not have any training, any 1st Aid/CPR certification or a Health Screen on file ( deficiencies cited, see 809D and civil penalties assessed for repeat violations within a 12 month period ). Staff S2 last training completed 2/23/22 and 1st Aid/CPR expired 1/16/24. Staff S4 last training completed 5/12/24 and 1st Aid/CPR expired 11/18/2018 (deficiencies cited, see 809D ). At approximately 4:45pm LPA and licensee conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. 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 LIC308- Designation of Responsibility Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with licensee and a copy of this report was given .