Routine inspection·October 7, 2025

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 10/7/2025 at approximately 10:00am, and met with Administrator Assistant, Lorena Madrigal. Administrator Mera Shaughnessey would arrive later after their scheduled morning appointment. There currently are six (6) residents residing in the facility; One (1) resident is currently hospitalized. Fire clearance is approved for six (6) non-ambulatory/bedridden residents, 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. Per record reviews, the facility conducted their last emergency disaster quarterly drill on April 4th & 5th, 2025. 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. LPA observed eleven(11) of eleven(11) smoke alarms; Smoke alarm system is hardwired, and is a carbon monoxide detector as well. The smoke alarm system was working properly during the inspection. LPA reviewed six (6) resident files. All files were complete. Two (2) residents are on hospice services. The LPA reviewed four (4) staff files. All staff have criminal record clearance. All staff have current first aid and CPR certification as required. LPA reviewed staff training. Continued on LIC809C... Continued from LIC809.. The LPA toured the facility with Administrator Assistant Lorena. Hot water was measured at 115.8 degrees Fahrenheit. All exit doors had auditory alarms, and the alarms were working properly during the inspection. Fire extinguishers, two (2) were serviced and tagged as required. There was sufficient food supply for perishable and non-perishable food; Assistant Administrator stated Tuesday is the facility's food shopping day, and additional supplies will be arriving today. There was a sufficient supply of cleaners/disinfectants, and these items were locked up and inaccessible to residents in care. There was a sufficient supply of linens, paper products, and furnishings. personal protective equipment (PPE). LPA observed sufficient lighting in resident rooms, bathrooms, hallways, and all common areas. Medications were locked up and inaccessible to residents in care. Medications needing refrigeration were in a small refrigerator in the key pad locked pantry room, making the medications inaccessible to residents in care. All resident rooms have private bathrooms, each of them have grab bars for resident use. Each resident's bathroom has a shower head for showering the resident, and the facility has a large roll-in shower room in the hallway for resident use if wanted. The large roll-in shower room has grab bars, and a bathing shower mat. Facility was at a comfortable temperature during the inspection. LPA observed majority of the residents up, and engaged with staff in the facility common areas; LPA observed the residents having their noon meal. LPA is requesting the following documents be updated and submitted by 11/7/2025: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan - (review and update as needed/required-submit if changes) Infection Control Plan (review and update as needed/required-submit if changes) Copy of LIC400- Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate- (Mera Shaughnessey and Lorena Madrigal) Continued on LIC809C.. Continued from LIC809C.. LPA observed the following deficiencies: Residents' private bathrooms', six (6), with shower heads for bathing, all lack slip-resistant mats, strips, or flooring for residents use when bathing. Per staff interview, residents’ use their private bathrooms for bathing. This deficiency will be cited, 87303(e)(5) Maintenance and operation- Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors, see LIC809D. Per record review. facility missed the third (3rd) emergency disaster drill of facility's required quarterly drills. Last drill was conducted April 4th & 5th, 2025. This deficiency will be cited, 1569.695(c)- A facility shall conduct a drill at least quarterly for each shift. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill, see LIC809D. 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. Appeal rights given to the Assistant Administrator. Exit interview conducted with Administrator Assistant, Lorena Madrigal.