Routine inspection·July 15, 2025

At 1:30 PM on 07/15/2025, Licensing Program Analyst (LPA) Triel Ellen Lindstrom arrived at the facility `unannounced to conduct a required annual inspection and was greeted by a Caregiver. The LPA identified herself, explained the purpose of the visit, and asked to meet with the Designated Facility Administrator (DFA). A second Caregiver called the Licensee to announce the LPA’s arrival. Venice Andrews, an Administrator for Golden Age facilities, arrived at the facility at 2:00 PM and a brief interview followed. The Administrator accompanied the LPA on a tour of the physical plant. The LIcensee arrived at 4:30 PM. The CARE inspection tool was used during this inspection. This facility was a four-bedroom house located in a residential neighborhood. It was licensed to serve six non-ambulatory residents and had a hospice waiver for six residents. The census was six residents and give residents receive hospice care. There were two Caregivers on duty at the time of this visit. The LPA toured the inside of the house, including four resident bedrooms, the kitchen/dining combination room, the two bathrooms, a family room, and the garage. The entire house was clean, odor-free, and pest-free. Two bedrooms were double-occupancy and two bedrooms were single-occupancy. Each occupied bedroom had the required furniture and closet space for personal belongings. The windows and window screens were in good repair. One bathroom was a shared bathroom located in a hallway. This bathroom had grab bars, a shower chair, and non-slip mats. The second bathroom was connected to the master bedroom. The bathrooms were clean and the water temperature at the bathroom sink was 109 degrees Fahrenheit. The LPA observed that the temperature in the house was set at 76 degrees Fahrenheit. There were three smoke detectors -one in the hallway near the bedrooms, one in the family room, and one in the living room. The LPA tested the detectors -all three are interconnected, are operable, and sounded an alarm. There is a carbon monoxide detector in the hallway as well, which sounded an alarm when tested. The fire extinguisher was located in the front living room. It was last serviced on 5/25/2025 by Jorgensen Co. The facility has conducted fire drills on a quarterly basis. The LPA toured the kitchen. The kitchen is clean, the appliances are operable, and the trash can had a lid on it. There is a seven-day non-perishable and two-day perishable supply of food located in the refrigerator/freezer, kitchen cabinets, and in a locked pantry in the kitchen. The refrigerator was thirty-seven degrees Fahrenheit and the freezer was zero degrees Fahrenheit. Kitchen cleaners were locked beneath the kitchen sink. The LPA toured the living room, dining room, and family room, which contained enough furniture for all residents, including a dining table and chairs, two couches, and recliners. The rooms are clean and windows let in natural light. The LPA toured the garage. The LPA observed additional food in a refrigerator/freezer and tall cabinets, as well as cleaners in a locked cabinet in the garage. The LPA toured the back yard, which included a concrete patio and walkways that were free of obstruction. There were chairs, a table, and large shade umbrella for resident use. There were ornamental plants planted along the backyard fence. The LPA inspected the central medication storage area. The first aid kit contained all the required items. Residents’ medication is kept in a locked cabinet in the living room. Each resident’s medication is stored separately in its original containers with intact labels. The LPA inspected one resident’s medication in depth. The medication counts matched the medication prescription lables. The LPA reviewed records for three residents and three staff. The LPA observed that the records were organized and complete. All staff associated with the facility have criminal background clearances, current first aid/CPR certifications, and proof of annual training. The LPA requested that updated copies of these documents be submitted to Licensing by 5:00 PM on 07/29/2025. These documents can be emailed to LPA at ellen.lindstrom@dss.ca.gov. (1) LIC 308 Designation of Facility Responsibility (2) Copy of a current Administrator Certificate (3) LIC 500 Personnel Report (4) LIC 610 Emergency Disaster Plan (5) Proof of Liability Insurance (6) LIC 309 Administrative Organization As a result of this inspection, no deficiencies were cited. The facility was in compliance with California Code of Regulations (CCR), Title 22, Division 6. An exit interview was conducted with the DFA, to whom a copy of this LIC809 report was provided. Their signature below confirms receipt of this document.