Routine inspection·September 8, 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 four (4) residents present. The LPA was greeted by staff and at this time the reason for the visit was explained. The facility designee, Sara Jackson arrived at approximately 10:10 a.m. Entrance interview conducted. During today’s inspection, the LPA along with the facility designee 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 10:30 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 07/07/2025. Required postings were observed throughout the common space. There is a working telephone on premises. Cameras observed in the common areas. Activities were observed in the living room. 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 #4. 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 10:19 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 in care. BEDROOMS: There are four (4) bedrooms for resident use. Two (2) bedrooms are designated as double / shared occupancy, and two (2) 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. All passageways were observed to be clear of any obstructions. There is (1) side gate with latching mechanisms. No bodies of water noted at the time of the visit. RECORDS: The LPA began record review at approximately 09:35 a.m. Four (4) 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. Interviews with staff revealed that the Administrator designated by the licensee is not present at the facility during normal working hours and a notice to the department was not sent designating a facility manager which will be present at the facility when the Administrator is temporarily absent from the facility. 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 07/07/2025. MEDICATIONS: Medications review began at approximately 12:00 p.m. Medications are centrally stored and kept in a locked file cabinet adjacent to the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications are properly documented on the Centrally Stored Medication & Destruction Records and appear to be administered as prescribed at the time of the visit. 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.