Routine inspection·July 10, 2025

At 09:35 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA met with C0-Administrator Johnna Macanin and informed them of the reason for the visit. At 09:45 a.m. the LPA conducted a tour of the physical plant with the Administrator to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of two (2) private bedrooms and two (2) shared bedrooms. Bedroom #2 has direct access outside. The LPA observed fire extinguishers which were fully charged and purchased on 05/17/2025. All smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings in the hallway near the entrance area. Kitchen : The facility has at least seven (7) day supply of non-perishable food and two (2) days perishable food. Appliances and all equipment appear to be clean and in good repair. Kitchen knives, sharps, and cleaning supplies were observed in locked cabinet. Bedrooms: Each bedroom is equipped with clean mattresses, pillows, and bedding. There is a closet in the hallway with a sufficient supply of linens, including blankets, bath towels and wash cloths. Bedrooms have sufficient lighting. Bathrooms: There is two common restrooms in the hallway and one private restroom in bedroom #2 . The LPA observed bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. At 09:58 a.m. water temperature in the private restroom was measured at 111.2 degrees Fahrenheit and at 115.2 degrees Fahrenheit in one of the common bathrooms. Report will continue on LIC9099-C, 2nd page. Common Areas: The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. A working telephone is present. There are activity supplies in the living rooms. All doors have functioning auditory alarms when opened. At 10:15 a.m. the LPA observed the Administrator administered medication to a resident by feeding it to them via a spoon. The garage/Laundry room: The laundry room holds the washer, dryer and detergent and was observed locked and inaccessible to the residents in care. The garage is accessible from the house; the doors were locked from the inside of the house. Toxic or danger items or tools in the garage, were locked in a cabinet during the visit. Emergency food and water is stored in the garage. Surrounding Grounds (Outdoors) : The exterior passageways were clean and clear of any obstructions. There is a covered patio area with outdoor seating. The entire property is fenced. The back and sides of the house are separated from the front yard by a gate and fence Record Review: At 11:10 a.m. a review of facility files was initiated. The LPA reviewed five (5) out of six (6) resident files. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. The LPA reviewed five (5) out of seven (7) Personnel files. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Facility records are stored in the locked closet in the living room. The LPA observed documentation of Infection Control, Disaster prevention and last Disaster drill (conducted on 05/01/2025). The LPA obtained Client Roster, Staff Roster and Insurance liability. Medication Audit: At 12:00 p.m. the LPA conducted Medications audit for two (2) residents. The medications are locked in a locked closet in the living room. Medications are labeled and checked for expiration dates. Medications are documented on the centrally stored medications and destruction record. During Resident 1's (R1's) audit the LPA observed an under count of Acetaminophen by one (1) pill based on the start date and quantity. Upon observation, the Administrator called the staff responsible for the medications and they stated they wrote the wrong start date in error. I nterviews: The LPA conducted two (2) resident and two (2) staff Interviews. No immediate concerns were voiced by the residents. Staff interviews revealed that medications are not self-administered at times and staff put the medications into the resident's mouth. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided to the Administrator.