Facility Evaluation Report

Licensing Program Analyst (LPA) Sabrina Calzada and Licensing Program Manager (LPM) Maribeth Senty

arrived unannounced to conduct a required annual. LPA and LPM initially met with staff, Ram Pratap. The Administrator Designee, Steve Heydon, arrived within (5) minutes, and the Administrator, Anita Heydon, arrived at 12:45 pm. LPA observed (1) resident watching television in the common area and (3) residents resting in their rooms. A resident returned from attending their health care program around 1:30 pm, and a new resident moved in at 3:30 pm today. There are currently (0) residents under hospice care.

LPA, LPM and the Administrator Designee toured the interior/exterior of the facility including the common areas, (1) shared (3) private resident rooms, (2) resident bathrooms, kitchen, and garage/ laundry area. LPA observed the facility to be clean, in good repair and odor-free. There is 2+day perishable and 7+day non-perishable supply of food. Sharps and medications are locked in the kitchen. Toxins are being stored in the laundry/garage area. The door to the garage has a lock but was not consistently locked during today's inspection. Currently 2/3 cabinets with toxins have a lock; a lock will be added to the third cabinet. The fire extinguisher was last serviced 5/2/2025; smoke/monoxide alarms are working. Front/back exit doors have sounding alarms- an alarm will be added to bedroom #5. Interior temperature measured 78*F. Hot water in the kitchen measured 113*F. Discussed updates to the Admission Agreement and the Dementia Care Plan, effective 1/1/25. Facility to use updated LIC613C- Personal Rights. (4) resident files and (3) staff files were reviewed. Files were organized and contained required documentation. Medications were reviewed for (2) residents- orders match medications being administered. MAR documentation is current. Staff to ensure required training hours are completed by 12/31/25-all staff have current First Aid/CPR and are cleared.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency is issued. Exit interview. Copy of report and appeal rights provided.