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Inspection visit

Routine inspection

ADOM MANOR CARE HOMELicense 4968038491 citation on this visit
1 citation recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver, but Administrator Eva Karikari arrived later. At approximately 9:30am 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. Extra food stored in garage along with canned goods. 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 sinks accessible to residents in care measured at 107 degrees F in bathroom by living room, 105.7 degrees F in kitchen, and 108.9 degrees F in the back hall bathroom which are all within the allowable range of 105 to 120 degrees F. Room #6 has a pump feature that enables hot water accessibility. Room #6 is located in a part of the house that was an addition to the facility so that is why the hot water from the hot water heater does not reach room #6 in a timely manner. Pump ensures hot water delivery in a timely manner. Caregiver demonstrated pump to LPA. LPA observed it to be in working order. Fire extinguishers were last inspected 3/2/25. Smoke/Carbon Monoxide detectors located throughout the facility were operational. Facility’s last quarterly disaster drills were conducted 4/25/25. Facility has a backup generator for use during a power outage. Continued on 809C... Continued from 809... At approximately 10:00am LPA conducted a review of 6 resident records. All required documentation present. While conducting physical plant inspection, LPA interviewed resident (R1) with caregiver present. R1 indicated their legs were hurting because they had been in their wheelchair for an extended period of time. R1 requested to be transferred but R1 is a two-person assist and only one caregiver was present at facility, as Admin had taken another resident to a doctor appointment. LPA and Admin discussed ensuring adequate staffing to meet residents' needs. At approximately 11:00am LPA conducted review of 5 staff records. All required documentation present. Training verified on Community Care Options website. At approximately 12:00pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. Eva Karikari Administrator Certificate 7014764740 expires 1/26/26. LPA and Administrator discussed facility's Infection Control Plan and Emergency Disaster plan. No new updates. 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 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 .

Citations

1 citation recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 1569.269(a)(6)Type A

    Based on LPA observation and interview, the licensee did not comply with the section cited above in that R1 requries a two-person assisst but only one staff present at facility, which poses an immediate health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the July 1, 2025 inspection of ADOM MANOR CARE HOME?

This was a inspection inspection of ADOM MANOR CARE HOME on July 1, 2025. 1 citation were issued: 1 Type A (serious).

Were any citations issued to ADOM MANOR CARE HOME on July 1, 2025?

Yes, 1 citation was issued (1 Type A, 0 Type B). The first citation was for: "Based on LPA observation and interview, the licensee did not comply with the section cited above in that R1 requries a t..."

What type of inspection was this?

This was a inspection inspection. inspection inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.