Routine inspection·April 9, 2025

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 4/9/25 at approximately 2:00pm, and met with Administrator Janine Sorenson.. Caregivers notified Licensee/Administrator that the LPA had arrived to conduct an inspection. There currently are six (6) residents in care. LPA observed two caregivers on duty. LPA reviewed six (6) resident files. All files were complete. LPA reviewed five (5) staff files. LPA reviewed staff training. LPA reviewed staff's first aid and CPR certifications. All staff have criminal record clearance as required. Facility has a fire clearance approval for 6 non-ambulatory of which 1 may be bedridden, in room #2 only. Fire extinguishers were serviced and tagged as required. Emergency fire & disaster drills are conducted as required. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three(3)residents. Facility has a required infection control plan. Facility has an emergency and disaster plan as required. Facility does have a generator for emergencies if needed. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. Hot water was measured at 113.3 degrees Fahrenheit. The exits were cleared and unobstructed. Food supply was sufficient. Sufficient furnishings throughout the facility. Sufficient lighting in all resident rooms, bathrooms, and common areas. Continued on LIC809C... Sufficient supply of linens, cleaners/disinfectants, and paper products. All medications were locked and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents in care. Bathrooms had grab bars and non-slip mats and/or shower flooring for resident use. LPA discussed the updated/changes in regulations with Administrator Janine Sorenson. LPA emailed the Departments PIN ASC- #24-09, regarding the regulation updates, to the Licensee/Administrator Ami Kumar and Janine Sorenson, Administrator. LPA are requesting the following documents be updated and submitted to CCL by 5/9//2025: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610 - Emergency Disaster Plan-update if needed-submit if changes Copy of Current Liability Insurance Copy of current Administrator Certificate Copy of updated Infection Control Plan- update if needed- submit if changes The following deficiency (s) was observed by the LPA during the inspection: Per LPA observation, there were two uncovered bowls of pureed food and/or what looked like soup, a plate with food not fully covered by the foil on it, and a large, uncovered blender jar filled with food to be pureed. This deficiency will be cited, 87555(b)(9) General Food Service Requirements- The following food service requirements shall apply: Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service, see LIC809D. Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator Janine Sorenson. Appeal Rights provided to the Administrator.