Routine inspection·December 2, 2025

On 12/02/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA was greeted by Staff Member (SM), Rita Southammavong and explained the purpose of the visit. LPA asked SM Southammavong to call the Facility Designated Administrator (FDA), Theresa Pettapiece that CCL was present. Shortly after, FDA Pettapiece arrived and met with LPA Pascua. Current census was 63. A brief interview with FDA Pettapiece was conducted. This facility is a full memory care facility licensed to hold and retain 72 non-ambulatory residents with a hospice waiver for 18. In addition, the facility has been approved for delay egress throughout the facility perimeter. LPA Pascua reviewed 5 resident files and 5 staff files. All files were complete and in compliance at this time. The FDA has a current and active administrator certificate #7025930740 and expires on 07/07/2027. There are currently 14 residents on hospice and 1 resident receiving home health services. A tour of the facility was conducted. This facility has a total of 60 bedrooms in which all are cleared for non-ambulatory residents. In addition, any bedroom can be used for a bedridden room. All rooms designated as activity areas and common areas for resident use were toured. Furniture and furnishings were observed to be present and sufficient to meet the needs of the residents at this time. Office rooms and other areas intended for resident use were toured. Kitchen area was toured. Facility freezer and refrigerator units were toured. LPA reviewed the food storage supply to make sure that there was always a 2-day perishable and 7-day nonperishable food quantities on site at all times. Knives were observed to be locked and made inaccessible to the residents at this time. It was observed in that the facility has cafe areas equipped with a microwave and addition refrigerator present to cool, heat, and warm up food of the residents if necessary. Storage area for chemicals and cleaning supplies were observed to be locked and made inaccessible to the residents at this time. A tour of the facility resident bedrooms was conducted. Furniture and furnishings were observed to sufficient and able to meet the needs of the residents at this time. A tour of the resident restrooms was conducted. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Additional incontinent supplies were also identified. Medication room was reviewed. It was learned that narcotics and all other medications were housed in medication carts that were used to store and dispense medications to the residents at this time. This facility has an electronic Medication Administration Record system. A brief interview was conducted with facility staff responsible for handling, dispensing, and documentation of the medications at this time. First aid kit was observed to be present and contained all of the required components at this time. First aid kit was observed to be present and contained all of the required components at this time. A tour of the facility memory care unit was conducted. Exterior grounds of this facility was toured. Perimeter fence and gates were observed to be functional and in good repair at this time. Delayed egress and other safety measures were observed to be functional at this time. Fire extinguishers, located and placed throughout the facility, were observed to have been annually inspected on 09/03/2025 by the local fire extinguisher company noted as Silicon Valley Fire and in compliance at this time. All smoke and carbon monoxide detectors were present and working at this time. The following forms and documents were requested to be updated and submitted into CCL: -LIC 308 -LIC 400 -LIC 500 -LIC 610e As a result of this visit, no deficiencies were observed or cited during this annual visit. An exit interview was conducted and copy of the 809 and 809-C was provided to Facility Designated Administrator.