Routine inspection·July 25, 2025

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required annual visit. Upon arrival, there were two (2) 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, Donald Brodt arrived at approximately 09:20 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 09:30 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 the fire extinguisher to be fully charged with a purchase date of 12/14/2024. Required postings were observed throughout the common space. The LPA observed a fireplace adequately covered at the time of the visit. There is a working telephone on premises. Cameras observed in the common areas. The LPA observed a closet in the hallway with emergency supplies. 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. 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 09:20 a.m., the hot water temperature was measured in both bathroom and they measured within the required range of 105 – 120 degrees Fahrenheit. BEDROOMS: There are five (5) bedrooms for resident use. One (1) bedroom is designated as double / shared occupancy, and four (4) bedrooms are designated as private rooms. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPA observed a staff bedroom on premises. 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. Washer and dryer were observed inside the garage. Additional cleaning supplies are kept in the garage locked and inaccessible to residents in care. BACKYARD: The backyard has a covered patio area with patio furniture for resident use. The LPA observed a shed used for storage purposes. All passageways were observed to be clear of any obstructions. There are two (2) side gates with latching mechanisms. No bodies of water noted at the time of the visit. RECORDS: The LPA began record review at approximately 09:55 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. Report Continued on LIC 809C... Report Continued from LIC 809C... 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. Training binder was observed but not completed. The Administrator completed at the time of the visit. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. The LPA also 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 06/23/2025. MEDICATIONS: Medications review began at approximately 11:45 a.m. The medications are kept in a locked cabinet inside the staff’s office. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. The LPA observed medications start dates missing on the Centrally Stored Medication Destruction Record (CSMDR) and start dates were not noted anywhere else, preventing the LPA from verifying whether the medications are being administered as prescribed. Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies are cited (refer to LIC809-D). Exit interview conducted. A copy of report and appeal rights were provided.