Routine inspection·August 19, 2025

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Jessica Robles. Administrator Certificate # for Jessica Robles is 7028206740 and expires 5/16/26. Facility contact information was reviewed. At approximately 10:00am LPA and Admin toured the building and grounds. While touring the facility LPA observed caregiver engaged in sensory activities with residents in the Main house. 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 items had date of opening marked on containers. Kitchen drawer with sharp knives locked. Cabinet containing cleaning supplies was 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 113.9 degrees F in the kitchen, 107.6 degrees F in cottage #3, 107.3 degrees F in cottage #2, 108.1 degrees F in cottage #1, and 109.7 degrees F in Main cottage which are all within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 8/5/24, but are showing as fully charged. Smoke/Carbon Monoxide detectors located throughout the facility are serviced by a vendor, last date of service was March 2025. Facility’s last quarterly disaster drills were conducted on 6/10/25, 6/12/25. Facility has a backup generator for use during a power outage. Continued on 809C... Continued from 809... At approximately 12:00pm LPA conducted review of six [6] staff records. S1 did not have a Health Screen on file ( deficiency cited, see 809D ). At approximately 1:30pm LPA conducted a review of six [6] resident records. Resident (R1) had razors accessible but on their physician's report it states that "at risk if allowed direct access to personal grooming and hygiene items." Per Admin, R1 likes to be independent as possible with grooming so Admin will continue to have caregiver present at all times while R1 is using grooming razors but will now keep razors in locked cabinet. 1/2 rails and crushed meds orders all on file for respective residents. R1 did not have clear TB result on file, however R1 did have a chest xray on file, but results not listed that Admin or LPA could find. Admin called to get clear TB screen with LPA present. At approximately 2:30pm LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored in a locked room. LPA advised Admin that all PRN and prescription medications must be listed on the Centrally Stored Medication Log (CSML). If a medication, PRN or otherwise, is no longer being administered, there must be a discontinuation notice on file. LPA and Admin discussed ensuring most current physician's orders are maintained on file. LPA and Admin discussed ensuring all instructions for medications be listed on CSML, even if a PRN. LPA and Admin discussed live pouring medications as they may not be pre-poured. Admin agrees to cease pre-pouring medications. 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 .