Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance lobby. The facility has s Infection Control Plan in file. Staff are adhering to infection control requirements.

Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. Hospice Waiver for 7 is approved. A fire clearance is in place. Fire Drill was last conducted on 4/14/2025. Disaster Drill was last conducted on 4/14/2025. Based on record review, Valid Liability Insurance was not file.

Physical Plant/Environment Safety: The facility is a 2-story building located in a residential community. The facility consists of: First floor: reception area, living room with covered fireplace, dining area, (11) resident bedrooms, administration office, break room, nurses/medication room, kitchen, storage room, laundry room, conference room and outdoor seating/patio areas. Second floor: (11) resident bedrooms, living room with covered fireplace, Food storage room, Electrical room, Break room, Housekeeping room, elevator/telephone/data room, and laundry room. Each bedroom has a smoke detector, bed, linen, dresser, light, chair and sufficient closet space.

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Room C1 - 113.1 deg F

Personnel Records/Staff Training: LPAs reviewed the Administrator and four (4) staff files and confirmed health screenings and fingerprint clearances. LPAs reviewed employee rights, staff training, health clearance, vaccinations and 1st Aid/CPR training. However, based on record review, Staff #2 (S2’s) file did not have a valid 1^st Aid training in file. Nathan Nemeth’s Administrator certificate is valid and will expire on 12/09/2026.

Resident Rights-Information: Resident personal rights are posted. Notice of visiting policy is posted. Per staff, facility provides internet services to all residents and have access to the facility phone. LPAs interviewed four (4) residents.

Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Sanitation practices and kitchen cleanliness was observed. Kitchen staff workers were observed to be using disposable gloves while working.

Incidental Medical and Dental: Five (5) centrally stored resident medications were reviewed; containing 30-day supply of medications. Medical and dental transportation is provided.

Resident Records/Incident Reports: Resident files are maintained at the facility. A total of three (3) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisal, TB clearance, Functional Capability Assessment, Physician's Orders, Medical consent, Medication records. RCFE complaint poster and Personal rights were observed posted in the 1st floor.

Disaster Preparedness: Emergency and Disaster Plan LIC 610E updated on 02/25/2025 and is in place. Records of resident Appraisal and Needs services plans are part of Emergency training.

Residents with Special Health Needs: Currently, one (1) resident receives hospice care and zero (0) bedridden residents.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809-D. Exit interview, appeals rights and a copy of this report were provided to the Administrator, Nathan Nemeth.