The facility is licensed to serve residents ages sixty (60) and older, including up to six (6) non-ambulatory residents, of whom one (1) may be bedridden. Bedrooms #1, #2, and #3 are approved for non-ambulatory residents. Bedroom #4 is approved for a bedridden resident. The facility may retain no more than six (6) residents receiving hospice care. At the time of inspection, two (2) residents were receiving hospice services.

There four (4) hospice resident at the time of the visit and two (2) on home health.

Facility Tour & Observations

Personal Rights postings (LIC 613C and Ombudsman), Complaint Poster (PUB 475), and nondiscrimination notice were observed in a common area. Oxygen was observed in use in the facility. Required “Oxygen in Use / No Smoking” signs were posted throughout the facility in visible locations. Residents had access to personal space, privacy, and adequate storage. No firearms/weapons were present.

Physical Plant

The facility is in a residential area and is a one-story home consisting of five (5) resident bedrooms, living room, kitchen, laundry room, dining area, laundry room, garage, front yard, and backyard. LPA observed five (5) resident bedrooms, and all contained the required furniture (bed, mattress, linens, dresser, chair, and lighting). Cleaning supplies and toxic substances were inaccessible to residents locked in a kitchen cabinet under sink. Bathrooms were clean and equipped with required grab bars in showers and near toilets, as well as non-skid mats; hot water measured in bathroom (1) 111.2°F, bathroom (2) 109.5°F bathroom (3) 112.3 °F and which is within the required 105–120°F. Extra linens and towels were available in a hallway cabinet. Smoke/carbon monoxide detectors were functional; fire extinguisher mounted by the living room area. There were no bodies of water present. Backyard provided shaded seating. Passageways and exits were observed to be clear and unobstructed. (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.

Refrigerators and freezers were maintained at proper temperatures (refrigerators at a maximum of 40°F and freezers at 0°F) and contained a sufficient supply of food, including at least a two (2)-day supply of perishable food and a seven (7)-day supply of non-perishable food. Fresh produce, proteins, and dry goods were observed to be adequately stocked. Knives were observed stored in a locked kitchen drawer. Two additional refrigerators located in the garage contained extra food supply. A cabinet containing additional canned goods was also observed in the garage.

Health-Related Services & Records

Four (4) resident files were reviewed and were found to contain current required documentation, including Admission Agreements, Pre-Placement Appraisals, signed consents, Needs and Service Plans, Physician’s Reports documenting ambulatory status, Resident Rights acknowledgments, and medication records. Medication Administration Records (MARs) were observed and found to be complete and in compliance.

Four (4) residents’ medications were reviewed. Medications were observed to be centrally stored in a locked cabinet located between the kitchen and laundry room.

Disaster Preparedness

Last fire/earthquake drill was conducted on January 5, 2026, with logs available. LIC 610D Emergency Disaster Plan was posted on front entry bulletin board. Emergency supplies (water, food, flashlights, batteries, first aid) were observed in the garage. Infection Control Plan was updated.

Personnel Records & Training

Three (3) staff files were reviewed and were found to contain criminal record clearances. Current CPR and First Aid certificates, tuberculosis (TB) screening documentation, and required training records were also observed in each staff file.

Insurance

Liability insurance was in compliance with an expiration date of April 2, 2026.

At the time of the visit, the facility was found to be in compliance with Title 22, Division 6 regulations. No deficiencies were cited during the inspection. An exit interview was conducted with Administrator Marjorie Hechanova. A copy of this report was provided via email.