Routine inspection·June 10, 2025

Licensing Program Analyst (LPA) Cuadra conducted an unannounced Annual Required Inspection and met with Licensee Nicholas Ray. Licensee informed of outstanding fees of $247.50. LPA/Licensee initiated a tour of the facility at 9:00 am. Facility passageways were free of obstruction and comfortable temperature. Smoke detectors and carbon monoxide was tested and operational. Two fire extinguishers were charged and serviced November 2024. Working auditory alarms are placed on all exits. Disinfectants and cleaning solutions were stored inaccessible to residents. Hygiene and bedding supplies were available. The facility has supplies of non-perishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. Last disaster drill have been conducted within the last quarter (6/1/25). Required postings were observed. During tour of the facility LPA/Licensee observed a intake vent that needs cover located in the hallway leading to bedroom #4 (technical violation issued). At approximate 9:15 am LPA/Licensee observed hot water temperature measured at 129.9 and 134.8 degrees F which is not within the range allowed per regulation. Licensee adjusted water heater immediately. At approximately 9:30am LPA/Licensee had a conversation regarding no activities were conducted during LPA's visit. According to Licensee, there are some residents that go out for a quick walk, but there are others that no have any interest on doing them (technical violation issued). Continues on LIC809C... Continued from LIC809... During tour of the facility LPA/Licensee observed a camera located in the facility common area. Previously, LPA/Licensee discussed that if there were cameras located in common areas, all resident's admission agreements were needed to be updated reflecting the use of cameras without audio in common areas. However, during file review it was revealed that admission agreements were not updated as instructed by LPA during last annual conducted on 7/30/24 to indicate the use of surveillance cameras in the common areas. Licensee agreed to elaborate an addendum to admission agreements. LPA initiated file review at 10:00 am. LPA reviewed five residents files and three staff files. One out of five residents (R1) needs medical assessment to be updated. Two out of five resident's (R1 & R2) needs service plans needs to be updated. LPA/Licensee discussed Dementia regulation changes and provided resources including LIC602A form for their review. All four out of four staff do have current First Aid/CPR certificates and 20 hours of additional required training. Administrator Certificate for Nicholas Ray, 6027071740, expires on 6/24/2025. Medications and medication records were reviewed. Licensee to submit updates of the following documents by 6/27/2025: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and copy of liability Certificate. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. 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 Licensee and copy of this report was given.