Routine inspection·June 3, 2025

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Administrator Eden Relota. Eden Relota Administrator Certificate 7006928740 expires 11/25/26. At approximately 9:30am LPA and Admin 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. 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 sink accessible to residents in care measured at 106.6 degrees F in the main hall bath and 107.5 in room #5 which is within the allowable range of 105 to 120 degrees F. Rm #5 missing oxygen in use sign ( deficiency cited, see 809D ). Fire extinguishers were last inspected 1/30/25. Smoke/Carbon Monoxide detectors located throughout the facility were operational. Facility’s last quarterly disaster drill was conducted on 1/24/25 ( deficiency cited, see 809D ). Facility has a backup generator for use during a power outage. At approximately 10:30am LPA conducted a review of six [6] resident records. Residents R1, R2, R3, and R4 did have TB clearance on file ( deficiency cited, see 809D ). Additionally, LPA discussed with Admin that some physician reports look to be fabricated in that they were photocopied and the Admin's previous facility's Continued on 809C... Continued from 809... information on the front page was either whited out or crossed out and filled in with new facility name, as well as last signature page dates changed. Admin advised that they will avoid photocopying or crossing out information on physician's reports. At approximately 11:30am LPA and Admin conducted a spot check of medication and medication records. Resident (R2) most current physician's orders were dated 2023 and listed Ciprofloxacin in 400mg as a current medication. Per Admin this medication was discontinued but Admin could not produce discontinuation order/notice ( deficiency cited, see 809D ) At approximately 11:45am LPA conducted review of five [5] staff records. Training records show the same date for all employees and shows in one instance of 8 hours on 2/1/25. LPA discussed with Admin, if all employees are training for 8 hours on that day, who is caring for residents. Admin advised that she did not conduct all 8 hours of training on that day, but sporadically. LPA asked Admin to see current training materials. Admin showed LPA Community Care Options (CCO) web modules with date of publication 2004, used by accessing one sign in. LPA and Admin discussed conducting training with current training materials that are at most 10 years old. Admin advised LPA they have chosen to use CCO going forward and each employees will have printable certificates that are not photocopied and filled in, but rather populated from CCO themselves. 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 .