Routine inspection·July 10, 2025

On 07/09/2025, Licensing Program Analyst (LPA) Triel Ellen Lindstrom arrived unannounced at the facility to conduct a required annual inspection. The LPA met with Designated Facility Administrator (DFA) Larry Potter. The LPA introduced herself, explained the purpose of the visit, and conducted an interview with the Administrator. The DFA accompanied the LPA on a tour of the facility. The facility is a two-story building that is licensed for one hundred and ten residents. The facility has a hospice waiver for fifteen. The census was eighty-eight at the time of this inspection. The facility was remodeled in 2024, including new flooring, paint, and furniture throughout the common areas of the facility. In addition, the upstairs activity area was outfitted with a large screen television and theater chairs, and the staff room was expanded and a kitchenette was added to it. The DFA began the inspection tour on the first floor in the large dining room located just inside the entry way. The room was carpeted and contained many tables and padded chairs. The room has a high ceiling and is lit by hanging light fixtures and natural light from windows. The LPA observed lunch being served between 11 AM and 1 PM. Service was restaurant style –staff takes residents’ orders at the table and food is delivered to the tables. There is a small adjacent private dining area separated from the main room by windows and a door with glass panes, which can be reserved by residents for private events. The LPA then toured the bistro, a small room near the dining area that has a small food service station and several tables. The dining room and bistro are both used for activities, including bingo, jeopardy, exercise classes, and word games. This report continues on page 2. The LPA observed the front entry desk, a section of which had been lowered during last year’s remodel to be more ADA accessible. Beyond this is a small front room with living room furniture, including couches and chairs, which residents can use to visit, rest, and watch television. Also on the first floor, the LPA toured a small, locked medicine room, which is used for the storage of overflow, incoming, and refrigerated medications. This room also contained a large first aid kit and a go-bag with first aid supplies. The LPA observed two laundry rooms on the first floor that are for use by residents who do their own laundry. There is also a fitness center and a commercial laundry on the first floor. While touring the hallways, the LPA observed multiple fire extinguishers, smoke detectors, and a sprinkler system, all of which were serviced by Jorgensen Company of Modesto on June 18, 2025. The facility used Universal Fire to monitor its alarms and notify the fire department. The DFA stated that the facility does disaster drills once a month for all three shifts, including for fire and earthquakes. The LPA observed two medication carts located downstairs in hallways. The medication carts contained resident medication. The carts locked and unlocked with a keypad, and drawers automatically lock when closed. The LPA interviewed a Med Tech and reviewed the facility’s electronic medication administration record and paperbased logs, and determined that medications and documentation were in compliance. The LPA toured the kitchen. The floors, walls, equipment, shelves, and appliances were clean. The hood was last serviced in April 2025 by Certified Kitchen Exhaust Cleaner. The LPA observed a food supply that was adequate for 2-day perishable and 7-day nonperishable in the refrigerators, freezer, and dry storage pantry. The LPA toured the upstairs of the facility. There are four staircases and one elevator between floors. The LPA observed evacuation chairs in the stairways and a certificate in the elevator from its last service on 11/25/2024. The LPA toured the beauty salon, activity area with its new seating and television, and a library with a sitting area, computer desks and a water station. The LPA observed two more med carts in the hallways and two more resident laundry rooms. The LPA observed three resident bedrooms. The bedrooms are clean, pest and odor-free, and have the required furniture. The LPA measured hot water in a resident sink at 124 degrees Fahrenheit, which is outside of the required temperature range of 85 to 120 degrees. The DFA corrected this during the visit. This report continues on page 3. The LPA toured the grounds, which consist of manicured grass lawns and ornamental bushes. The concrete walkways are free of obstructions. The backyard, accessed through the bistro, contained shade structures and seating for residents. There were also raised beds and a putting green. The LPA reviewed seven resident files and nine client files. All files were in compliance. The entire facility clean, odor and pest free, and had the required furniture. The LPA observed residents engaged in activities and socializing over meals. The LPA requested that updated copies of these documents be submitted to her by 5:00 PM on 7/28/2025. (1) LIC 308 Designation of Facility Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Emergency Disaster Plan (5) Proof of Liability Insurance (6) LIC 500 Personnel Report (7) LIC 309 Administrative Organization As a result of this inspection, the facility was not in compliance with California Code of Regulations (CCR), Title 22, Division 6. A deficiency was cited. The DFA corrected the deficiency during the site inspection by adjusting the water heaters. Please see the LIC 809D report for citations related to the deficiency observed during the inspection. An exit interview was conducted with the DFA, to whom copies of this LIC809 report, the LIC 809D, and the appeals rights were provided. Their signature below confirms receipt of this document.