Routine inspection·October 21, 2025

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by caregiver. Administrator Martha Marimbi arrived later. Administrator certificate number 7018478740 expires 3/21/27. Facility currently has six (6) residents in care, none of which are currently on hospice. At approximately 9:45am 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. Most food was found to be stored in a safe manner with open items covered, but not labeled with opened date. Boxes of pancake mix and a box of soup were found to be expired as of 2024. Bags of cereal found open and unsealed. Single serving cups of yogurt found open and not properly sealed. LPA and Admin discussed food storage and maintaining proper seals once food is opened. Drawer containing sharps accessible to residents in care, drawer had locking function but lock broken. LPA observed kitchen cabinet under sink to contain disinfectants and cleaning supplies accessible to residents in care, cabinet did not have a locking function present ( deficiency cited, see 809D ) All other cleaning products and laundry soaps are locked in a closet outside and inaccessible to residents in care. 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 bathrooms had required bath mats and grab bars. Water temperature in sinks measured at 110.9 degrees F in the kitchen, 112.9 degrees F in the cottage, 109.7 degrees F in the main bathroom, and 111.2 degrees F in room #2, all of which are Continued on 809C... Continued from 809... within the allowable range of 105 to 120 degrees F. Facility bathroom in kitchen had small puddle of urine present on floor on left hand side of the toilet ( deficiency cited, see 809D ). Fire extinguishers were last inspected 02/06/25. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility has fire alarm hardwired and serviced by vendor, last date of annual service was September of 2025 and last date of semi-annual service was March of 2025. Facility’s last quarterly disaster drill was not conducted within the quarter. LPA and Admin discussed ensuring quarterly disaster drills are conducted. Facility has a backup generator for use during a power outage. At approximately 12:30pm LPA conducted a review of six (6) out of six (6) resident files. LPA discussed with Admin importance of completing resident appraisals herself. In addition to her own appraisal, if she would also like the families to fill one out, that is fine. LPA and Admin discussed reviewing physician reports carefully and making sure to note important items that may put residents at risk if exposed, including any allergies and if the resident is allowed access to grooming products and devices. LPA and Admin discussed reporting requirements. LPA discussed with Admin that CCL has never received an Incident Report from this facility (and their other facility). LPA printed regulation 87211, went over details of instances requiring reporting and the time frames in which a report needs to be submitted to CCL. LPA gave printed copy of regulation to Admin. No deficiencies cited. At approximately 1:45pm LPA conducted a review of four (4) out of four (4) staff files. Staff (S1) and (S2) did not have Health Screens on file. S2 also did not have TB ( deficiency cited, see 809D ). S3 did not have current 1st Aid/CPR and works their shift alone ( deficiency cited, see 809D ). S1, S2, S3, and S4 did not have required training on file ( deficiency cited, see 809D ). At approximately 2:45pm LPA and Licensee conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. LPA and Admin discussed medication management requirements. LPA and Admin discussed TSP participation. Admin would like to participate. LPA will sign her up for TSP for medication management and reporting requirements. 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 and LIC308- Designation of Responsibility. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. 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 Administrator and a copy of this report was given.