The facility is licensed to operate for six (6) nonambulatory residents of which one may be bedridden and have a hospice waiver for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, one (1) staff room, three (3) bathrooms, living area, dining area, kitchen, outdoor covered patio, and an attached two car garage.

LPA Kim toured inside and outside of the physical plant with LI Nicolas. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, and Resident Room 5. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 105.2 degrees F to 110.8 degrees F. A comfortable temperature of 72 degrees F was maintained in the facility.

LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food is stored in the kitchen cabinet to the right of the refrigerator, and emergency water and emergency supplies are stored in the garage. The facility has one (1) fire extinguisher that is charged in the dining room and last inspected on July 1, 2024.

Evaluation Report Continues on LIC 809-C.

LPA Kim conducted an audit of six (6) resident files (R1-R6) and six (6) staff files (S1-S6).

Due to time constraint a continuation of this inspection will be conducted at a later date. LPA Kim will conduct a review of the medication and the medication administration record, first aid kit, video teleconferencing device, smoke detector and carbon monoxide detector check, staff interviews, and resident interviews.

Deficiencies were cited during this visit as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. A technical violation was issued at the time of the visit.

An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Carmen Nicolas