Routine inspection·September 10, 2025

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required annual visit. Upon arrival, there were three (3) staff and five (5) residents present. The LPA was greeted by staff and at this time the reason for the visit was explained. The Administrator, Iris Van Kralingen arrived at approximately 09:15 a.m. Entrance interview conducted. During today’s inspection, the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Kitchen: The LPA inspected the kitchen/food service area at approximately 09:18 a.m. Knives and sharps were observed locked and inaccessible in a kitchen drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. Common Areas: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed several fire extinguishers throughout the facility to be recently charged with a date of 06/15/2025. Required postings were observed throughout the common space. There is a working telephone on premises. Activities were observed in the living room. Auditory alarms were observed functioning during the inspection. No hazards/obstruction observed inside or out. Report Continued on LIC 809C... Report Continued from LIC 809... Restrooms: There are two (2) restrooms for resident use. The first bathroom is located by the main hallway and the second bathroom is located in bedroom #2. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 09:29 a.m., the hot water temperature was measured in both bathrooms, and they measured within the required range of 105 – 120 degrees Fahrenheit. Personal hygiene items were observed locked and inaccessible to residents at the time of the inspection. Bedrooms: There are three (3) bedrooms for resident use. All bedrooms are designated as double / shared occupancy. Resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPA observed a staff bedroom on premises. Laundry Room: The washer and dryer were observed locked and inaccessible to residents at the time of the inspection. Detergents and cleaning supplies were observed in a locked cabinet inside the laundry room. Garage: The garage was locked and inaccessible to residents at the time of the visit. The LPA observed an adequate amount of emergency food and water. An adequate amount of Personal Protection Equipment (PPE) was also observed. Outdoors: The backyard and front yard each has a covered patio area with patio furniture adequate for resident use. There is (1) side gate with latching mechanisms. The LPA observed a pool locked and inaccessible to residents in care at the time of the visit. All passageways were observed to be clear of any obstructions. Report Continued on LIC 809C... Report Continued from LIC 809C... RECORDS: The LPA began record review at approximately 09:42 a.m. Five (5) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All files were in order. Three (3) personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All files were complete. Emergency Disaster Planing: During today’s visit, the LPA reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; the last one was conducted on 09/08/2025. Medications: Medications review began at approximately 11:30 a.m. Medications are centrally stored and kept in a locked cabinet adjacent to the living room. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. During medication review, two out of four residents’ medication pill count did not match that according to the start dates on file. Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies are cited (refer to LIC809-D). Failure to correct deficiencies may result in civil penalties. Exit interview conducted. A copy of report and appeal rights were provided.