Routine inspection·July 14, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 11:32 AM. LPA met with facility staff who contacted facility Licensee Representative Dr. Rashiya Aggarwal and Administrator Eleanor Jimenez via telephone call. The Licensee Representative and the facility Administrator arrived to the facility at approximately 11:40 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 11:40 AM, the LPA, along with the Licensee Representative and the facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS : This includes the living room, dining room, and hallways. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contains chairs, a television, and activities for resident use. Additionally, the living room was observed to contain an appropriately screened fireplace. The dining room was observed to be clean and contained adequate amounts of seating for resident use. The dining room contained a fire extinguisher. It was fully charged and last serviced on 10/03/2024. The hallway was observed to contain a storage cabinet that contained linens and additional care supplies. LPA observed all required postings for the facility located on the living room wall and hallway wall. Combination fire alarms and fire doors were tested at 12:20 PM and functioned properly at the time of inspection. LPA observed cameras throughout the common areas of the facility. The Licensee Representative confirmed that the cameras do not record audio. Continued on LIC 809C. BEDROOMS : There are eight (8) bedrooms in the facility; six (6) are a single occupancy resident rooms and two (2) are staff bedrooms. LPA the Licensee Representative and facility Administrator toured all eight (8) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Auditory alarms were observed on facility exits and were functioning at the time of inspection. The staff bedrooms were observed to be properly secured and inaccessible to clients in care. BATHROOMS : There are five (5) bathrooms at the facility. Two (2) bathrooms are designated as shared/common resident bathrooms and three (3) are designated as a private resident bathrooms. All bathrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. One (1) shared bathroom was observed to contain an unsecured cabinet that contained Lysol disinfectant spray. LPA informed the Licensee Representative who secured the item at the time of the inspection. Grab bars were observed in resident showers and near resident toilets, all were properly secured. The water temperature was measured between 106.2 and 114.3 degrees Fahrenheit, which is within the range required by regulation. KITCHEN/LAUNDRY : The LPA observed the kitchen area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. LPA observed the laundry to be located adjacent to the kitchen. LPA observed an un-secured cabinet in the laundry to contain detergents and extra cleaning supplies. LPA informed the Licensee Representative who secured the cabinet at the time of the inspection. Additionally, the Licensee Representative had a conversation with facility staff educating them of the importance of securing cleaning chemicals at the facility. Continued on LIC 809C. OUTDOOR SPACE: The facility has two (2) emergency exit gates located in the back yard on either side of the facility. All fences/railings located at the facility were secured properly. LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed the backyard of the facility to contain a pool. LPA observed one (1) of two (2) gates to the pool to be unlocked and accessible to clients in care at the time of the inspection. LPA informed the Licensee Representative and the Administrator that an accessible body of water is a zero-tolerance violation and an immediate civil penalty in the amount of $500 will be assessed on today’s date (07/14/2025). The Licensee Representative and the Administrator stated that the pool cleaner did not lock the gate behind them after completing a pool cleaning. The Licensee Representative and the Administrator replaced the locks on the pool gate at the time of the visit and provided the key to staff to monitor the gate when future pool cleaning is conducted. Additionally, the Licensee Representative and the Administrator had a conversation with facility staff emphasizing the importance of ensuring bodies of water are not accessible to clients in care. RECORD REVIEW: Record review began at 12:26 PM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, first aid certification, consent forms, and personal rights. Two (2) staff files were reviewed. All staff files contained the required documentation and trainings. Four (4) resident files were reviewed. One (1) resident’s admission agreement was observed to be printed on the front and back of the sheet of paper. LPA informed the Licensee Representative and the Administrator that per Title 22 regulations all print in admission agreements shall appear on one side of the paper only. The Licensee Representative and the Administrator expressed understanding and agreed to re-print the admission agreement utilizing single sided printing. MEDICATION REVIEW: Medication review began at 01:39 PM. Medications are stored centrally and securely in a cabinet in the hallway. Medications for two (2) residents were observed. All medications observed were documented appropriately on their centrally stored medication and destruction record sheets and their Medication Administration Record sheets. No deficiencies were observed during medication review. Continued on LIC 809C. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility's last emergency disaster drill was conducted on 06/27/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan were reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed one (1) staff and one (1) resident. The resident interviewed stated that the staff treat them well and are attentive to their needs. The resident interviewed had no concerns with the facility. The staff member interviewed was knowledgeable on their role and responsibilities, resident rights, the different forms of abuse and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies and civil penalty were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.