Routine inspection·August 6, 2025

Licensing Program Analyst (LPA), Alviso conducted a required -1 year inspection, at approximately 2:25pm 8/6/2025, and met with Licensee Teddy Rico. There are currently six (6) residents in care. Fire clearance is approved for six (6) non-ambulatory only. The facility has a staff room for three live-in caregivers. The facility's last emergency disaster drill was conducted on 5/18/2025. The facility does have emergency food/water and emergency supplies to meet the "72 hour shelter in place" requirements. Facility has an approved dementia plan of operation. Facility has a hospice waiver approval for two (2) residents. Facility has a required infection control plan and emergency disaster plan. LPA reviewed six (6) resident files. All files were complete. LPA reviewed five (5) staff files. All staff had criminal record clearance as required. LPA reviewed staff annual training. Staff S2 & S3 have first aid certification and CPR certification. Hot water was measured at 111.7 degrees Fahrenheit. LPA observed sufficient supply of food, perishable and non-perishable, for resident meals/snacks. Facility had sufficient furnishings for residents in care. The facility has sufficient lighting in all rooms, bathrooms, and common areas, including night lights. There was a sufficient supply of hygiene products, linens, cleaning supplies, and paper products for use as needed. All exits were free and clear of obstruction. Fire extinguisher was charged, in the green area, tag expires 10/2025. The facility was at a comfortable temperature for residents; Residents were observed to be watching television, listening to music, and engaging with the staff. All bathrooms had grab bars, and non-slip mat/flooring for bathing/showering as needed; Facility has a sufficient supply of personal protective equipment(PPE). All medications were stored, locked up, and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents in care. The backyard has a shade covered sitting area for residents in care. Continued on LIC809C.. LPA is requesting the following documents be updated and submitted by 9/6/25 LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Submit if any changes. Infection Control Plan- (ensure to review and update as needed/required) Submit if any changes. Copy of LIC400 Handling of Client Cash Resources-complete & submit Copy of Surety Bond- if handling cash Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate Following deficiencies that will be cited, see LIC809D: Per LPA review of records, there was no proof of staff, S2 and S3, having obtained required annual medication training. Deficiency cited, HSC 1569.69 (b) -Employees assisting residents with self-administration of medication; training requirements. Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period. Per LPA review of records, there was no proof of staff, S2 and S3, having obtained required annual direct care staff training. Deficiency cited, HSC 1569.625(b)(2) Staff training; legislative findings; contents - In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. Deficiencies 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 Licensee Teddy Rico. Appeal rights provided to the Administrator.