Facility Evaluation Report

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with facility Administrator Jennifer Vasquez, Continual Administrator's Certification expires 07/24/2025. Application to renew Jennifer Vasquez's Administrators certificate was received by Community Care licensing Administration Certificate Bureau on 06/17/2025. There are currently 63 residents who reside at this home and there is 3 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, and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.

LPA reviewed the facilities Infection control plan, Emergency Disaster plan, Plan of Operation. LPA reviewed a sample of staff and resident files.

Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible.

LPA observed Resident 1's bedroom did not have required sign indicating Oxygen in use. LPA observed several bedroom showers without non slip flooring mat. LPA observed Resident 2 does not have required bedroom furnishings (dresser.) Water temperature in Room 107 measured 123 degrees. Resident 3 and Resident 4 do not current hospice care plans. Resident 5's medication count was off by 2, and Resident 3 was given one extra dose of medication on 07/16/2025.

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 Administrator Jennifer Vasquez, and copy of report left at facility