The facility is licensed to provide care and supervision for sixty (60) non-ambulatory residents. All resident bedrooms are approved for non-ambulatory use. The facility is approved to retain no more than twenty (20) residents receiving hospice services. At the time of the inspection, there were five (5) residents receiving hospice care.

This version improves grammar, readability, and follows the formal style typically used in Community Care Licensing inspection reports.

Physical Plant and Environmental Safety:

The facility is a two-story building consisting of forty-three (43) resident bedrooms, two (2) activity rooms, an outdoor courtyard, two (2) dining rooms, a first-floor side patio, a second-floor terrace patio, a conference room, lobby, kitchen, employee lounge, and administrative offices. LPA inspected the interior and exterior physical plant. Exit doors were observed to be free of obstructions and accessible for emergency evacuation. Cleaning supplies and other toxic substances were observed to be stored in a manner that made them inaccessible to residents. LPA inspected ten (10) resident bedrooms and their associated bathrooms. All bedrooms contained the required furnishings in accordance with licensing regulations. Resident bathrooms were equipped with grab bars and non-slip flooring to promote resident safety. During the walkthrough, LPA observed housekeeping and maintenance issues that require correction. A deficiency will be issued. Water temperature readings taken during the inspection did not measure within the required range of 105°F to 120°F. The facility is equipped with evacuation chairs located in the stairwells for use during emergencies to assist residents in safely exiting the building. The facility also has an operational fire sprinkler system, smoke detectors, carbon monoxide detectors, and fully charged fire extinguishers. The most recent fire inspection was conducted by the California State Fire Marshal on January 20, 2025. (continued on 809C)

• 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.

LPA toured the kitchen and food storage areas. The kitchen was observed to be clean, organized, and in good sanitary condition. Refrigerators and freezers were maintained at proper temperatures, with refrigerators at or below 40°F and freezers at 0°F. The facility maintained a sufficient supply of at least two (2) days of perishable food and seven (7) days of non-perishable food. The facility utilizes Grove Menus by Aline, which provides dietitian-approved menus and recipes for kitchen staff to follow. The facility also has a system to ensure residents with physician-ordered special diets receive the correct meals.

Planned Activities:

LPA observed residents participating in scheduled activities, including music therapy. Weekly and monthly activity calendars were posted and included a variety of recreational activities for residents. LPA observed adequate outdoor recreational space for residents.

Resident Rights/Information:

LPA observed the required postings displayed throughout the facility's common areas, including the Complaint Poster (PUB 475), Personal Rights, and the Nondiscrimination Notice.

Health-Related Services & Records

Six (6) resident files were reviewed. Files contained current required documentation, including Admission Agreements, signed consents, Needs and Services Plans, Physician's Reports documenting TB results and ambulatory status, and signed Resident Rights acknowledgments. Residents' medications were reviewed. Medications were observed to be centrally stored in the facility's medication room in locked medication cabinets, locked medication carts, and a locked medication refrigerator. All medications observed were maintained in a secure manner and inaccessible to residents. During the medication review, LPA observed missed medication documentation in resident records. A deficiency will be issued.

Disaster Preparedness

LPA reviewed the facility's LIC 610D, Emergency Disaster Plan. Emergency disaster supplies, nonperishable food, flashlights, batteries, and first aid supplies, were observed and appeared sufficient to meet emergency preparedness requirements.

(continued on 809C)

Five (5) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Subashasi Kumar, Administrator was valid through December 27, 2027.

An exit interview was conducted with Subashasi Kumar, Administrator. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and appeal rights will be provided.