Routine inspection·July 9, 2025

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 10:00 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator, Cilva Toume and Vana Barberis Assistant Administrator arrived shortly after and the reason for the visit was explained. Entrance interview. INTERVIEWS : From 10:05 a.m. – 10:29 a.m. two (2) staff and four (4) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. The LPA and 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. 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. At 1:30 p.m., hardwire combination of smoke / carbon monoxide detector and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 05/05/2025. The emergency telephone numbers are posted in common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 07/09/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. There is a functioning telephone on the premises. Report Continued from LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809... BEDROOMS: There are six (6) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms. There are two (2) additional staff rooms / areas (converted garage and laundry/closet space) that have been added / converted without permits, however a LIC200 was submitted on 07/23/2024 to document the change and schedule a fire clearance inspection. The staff rooms / areas are kept locked at all times. RESTROOMS: There are three (3) restrooms. Two (2) are designated as shared / common restrooms and one (1) is designated as a private resident restroom. Resident restrooms were observed to be equipped with nonslip surface. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The water temperature was measured all resident restrooms and ranged between 113.2- 116.1 degrees Fahrenheit, all within the required range. KITCHEN: The LPA inspected the kitchen/food service area at 11:16 a.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. There were three (3) meat products in the freezer that did not have a date which poses/posed a potential health, safety or personal rights risk to persons in care . At the time of the visit the date was added. The kitchen faucet was measured for hot water temperature, and it measured 110.8 degrees Fahrenheit at 11:17 a.m. Cleaning supplies and other chemicals are kept in a cabinet under the sink. At 11:18 a.m. the cabinet under the sink was unlocked with multiple cleaning chemicals / solutions which poses/posed an immediate health, safety or personal rights risk to persons in care. At the time of the visit the Administrator locked the cabinet and spoke to staff about the importance of ensuring chemicals are locked and inaccessible to residents in care. LPA observed an adequate amount of emergency food and water in a closet / pantry adjacent to the kitchen. BACKYARD: The entire property is fenced. There is a laundry area /room, with a washer and dryer that remains locked at all times, laundry detergent was observed. The backyard has a portable umbrella for shade with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed two (2) self-latching gates. Facility has an in-ground pool, which was observed to be fenced with an appropriate lock. Emergency exits and passageways were observed free of obstructions and hazards. Report Continued from LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... RECORDS: Record review began at approx. 11:36 a.m . Resident Records were reviewed beginning at 11:36 a.m. and Personnel Records at 12:23 p.m. Six (6) 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 records were in order. Six (6) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. MEDICATIONS: Medications review began at approximately 2:35 p.m. The medications are in a locked drawer located in the kitchen . Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. LPA obtained the following documents - Resident roster LIC 9020, Staff roster -LIC 500, and a copy of the Limited Liability insurance. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. The Licensee was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.