Routine inspection·August 26, 2025

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Janine Sorensen, back up Administrator arrived later. Administrator is Ami Kumar, Administrator Certificate 7006603740 expires 11/8/26. Facility contact information was reviewed. At approximately 1:15pm 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. 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 mats and grab bars. Water temperatures in sink accessible to residents in care measured at 117.8 degrees F in the kitchen, 115.2 degrees F in room #1, 107.9 degrees F in room #3, 111.2 degrees F in room #4 which are within the allowable range of 105 to 120 degrees F. However, water temperatures in sink accessible to residents in care measured at 95.4 degrees F in room #2 and 96.7 degrees F in the restroom in the hallway which are not within the allowable range of 105 to 120 degrees F. Per Janine, facility only has one water heater. Admins will work with licensee to bring those two rooms up to a temperature within regulation. Continued on 809C... Continued from 809... Fire extinguishers were last inspected 10/18/24. Smoke/Carbon Monoxide detectors located throughout the facility were operational. Facility’s last quarterly disaster drills were conducted 7/20/25 and 7/25/25. Facility has a backup generator for use during a power outage. At approximately 2:15pm LPA conducted a review of six [6] resident records. Residents R1 and R3 did not have a current appraisal on file ( deficiency cited, see 809D ). Resident (R2) did not have TB clearance ( deficiency cited see 809D ). LPA observed hoyer lifts for residents in care. However, per Admin, facility does not staff two caregivers on the NOC shift. LPA and Admin discussed needing two caregivers in order to operate the hoyer. Staffing ratios are not specified in regulation. However, LPA and Admin discussed reviewing the residents' physician reports to see who needs assistance with transferring and repositioning in addition to those requiring a hoyer lift, as the needs of residents will dictate staffing ratios. Per LPA observation and record review it appears as if two caregivers would be required per shift. At approximately 3:00pm LPA conducted review of five [5] staff records. Staff (S1, S2, S3, S5) did not have TB clearance and S4 and S5 did not have Health Screens on file ( deficiency cited, see 809D ). At approximately 4:00pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. Expirations dates for R3's Valacyclovir, Lisinopril, Furosemide, Sennas, and Carvedilol all had incorrect expiration dates listed on Centrally Stored Medication Log (CSML). Admin immediately corrected expiration dates on CSML. Medications listed on CSML did match current physician's orders. Per Admin, facility is now using e-Mar through a vendor. LPA asked caregiver to demonstrate use of e-Mar, caregiver successful in demonstration. LPA and Admin observed medications to be pre-poured in medication cabinet ( deficiency cited, see 809D ). Continued on 809C(2)... Continued from 809C... 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 Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given .