Facility Evaluation Report

Licensing Program Analysts (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Staff Shawn Walton, and Facility staff Dr. Barnes, Continual Administrator's Certification for Licensee Administrator Mukesh Patel expires 05/02/2028. There is currently 1 residents\ who reside at this home and there is 0 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair Food supply is adequate for 2-day perishable and 7-day nonperishable.

Water temperature was tested at 117 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible.

The facility staff present does not have access to staff or residents files for review. There is no Centrally stored medication record available for review. The facility residents do not have PRN authorization form available for review. LPA observed Resident 1's medication removed from original containers and placed to be dispensed in large monthly medication organizer. LPA observed the facility closet storing resident medications unlocked and accessible to residents. Resident 1's medication is is stored on night stand next to bed. Resident 1's Physician report documenting if they are able to administer own medications is not available for review. The facility is not performing disaster drills as required. The facility does not have a Plan of Operation available for review. Fire extinguisher is not within the safety regulation period (purchased on 06/2025.) LPA observed multiple food containers inside refrigerator with no dates or label. Additional deficiencies will be added at a later date if warranted.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Facility Licensee, Dr. Barnes, and facility staff Shawn Walton, and copy of report left at facility