Routine inspection·August 19, 2025

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility unannounced to conduct a required annual visit. Upon arrival, LPA met with staff and later with one of the Administrator, Kim Anderson. Reason for the visit was explained. At 10:45 a.m., the LPA along with the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards. Facility is fire cleared for six (6) non-ambulatory rooms, of which one (1) may be bedridden. The facility has a hospice waiver for six (6). The LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. Facility has six (6) non-ambulatory resident bedrooms, one (1) staff room and one (1) room used for staff office/rest area. BEDROOMS: The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms observed appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. The staff bedroom and office/rest area observed locked during today's visit. BATHROOMS: There are six (6) total bathrooms, four (4) for resident use, one (1) for staff use and one for guests. All bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The hot water was measured within 105 - 120 degrees Fahrenheit . KITCHEN: 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. COMMON AREAS: Furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. (Continue to LIC809c). Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The last emergency disaster drill took place on 6/24/2025 and conducted every three months. Activities were observed in the common areas; required postings observed posted. Exit alarms and Smoke/Carbon Monoxide detectors observed operable during visit. ST ORAGE/ OUTDOORS: Storage areas observed locked and inaccessible at the time of visit. Fire extinguisher observed with purchase date 06/03/2025. An adequate supply of emergency food and water was observed. Sufficient supply of Personal Protectant Equipment (PPE) observed. Cleaning supplies and toxins observed in the storage area inaccessible to residents in care. Laundry area observed with washer and dryer. Detergents and other cleaning supplies stored inaccessible to residents. The backyard has a shaded area with furniture for resident use. The LPA observed two (2) gates that self-latches with a clear passageway in case of an emergency. Garage is converted into office space. RECORDS: Records review began at 12:30 p.m., five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Resident files observed complete. Two (2) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Staff files observed complete. MEDICATIONS: Medications review began at approximately 2:25 p.m. Routine medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. No medication errors observed at this time. Following deficiency observed during today's visit: The licensee has retained a resident (R1) with a feeding tube. Interview with staff revealed that the facility care staff are responsible for providing meals, fluids, and medication through the G-tube for R1. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Exit interview conducted. Copy of the report provided.