4K Senior Home

Type of visit: Required - 1 Year

At approximately 12:20pm, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. Maria Socorro Hernandez, Administrator and Licensee, was contacted via telephone and arrived at facility at approximately 12:45pm. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care, four (4) of whom were present during today's inspection and two (2) were away at their day program. Facility has a Dementia Care Plan, a Hospice waiver for six (6), is approved for all non-ambulatory residents, and is vendored with the North Bay Regional Center (NBRC). At approximately 1:00 PM, LPA initiated a tour of the facility with Licensee and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPA observed egress devices activated on all facility doors. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. LPA inspected a locked storage shed in the backyard which contained care equipment, supplies, decorations, and furniture. LPA observed residents watching TV, coloring and reading in the common area. Continued on LIC809-C... Continued from LIC809C... Facility has internet service and an internet access device designated for resident use. The telephone was tested and was operational during inspection. Smoke and carbon monoxide detectors were tested and operational during inspection. Fire extinguisher was observed fully charged and was last inspected 04/2026. Emergency Disaster Plan was reviewed and updated 04/2026. Facility conducts quarterly disaster drills with the most recent drill conducted 06/2026. At approximately 1:45pm, LPA conducted file review of four (4) staff and three (3) resident files. Four (4) of four (4) staff files reviewed contained all the required documents and proof of current First Aid and CPR certification. Three (3) of four (4) staff files reviewed were observed with all of the required proof of training. LPA advised Licensee that all new staff who will be giving medications shall have proof of the required initial medication training prior to giving medications. LPA provided Licensee a copy of the relevant Health and Safety Code statutes for reference and Licensee agreed to bring the facility into compliance immediately. Three (3) of three (3) resident files reviewed contained all the required documentation. Licensee state that facility assists with coordinating medical and dental appointments as well as transportation to and from appointments when residents have the need. Medications and medication records were inspected. Medication logs were observed missing start and expiration dates. Licensee agreed to ensure all medication records and logs are maintained in compliance with regulation moving forward.. P&I was observed stored and maintained in compliance with regulation. No deficiencies were cited during today's inspection. Exit interview conducted with Licensee whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jun 25, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 12:30pm, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a required 1-year annual inspection and was greeted by staff. Maria Socorro Hernandez, Administrator and Licensee, was contacted via telephone and arrived at facility at approximately 12:45pm. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care, four (4) of whom were present during today's inspection. Facility has a Dementia Care Plan, a Hospice waiver for six (6), is approved for all non-ambulatory residents, and is vendored with the North Bay Regional Center (NBRC). At approximately 1:00 PM, LPA initiated a tour of the facility with Licensee and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. LPA observed egress devices activated on all facility doors. Water temperatures in residents' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. Facility has at least two days of perishable food and one week of non-perishable foods, as well as an emergency water supply. Medications were centrally stored and locked. There is a shaded seating area in the backyard with outdoor space for activities. LPA inspected a locked storage shed in the backyard which contained care equipment, supplies, and furniture. LPA observed residents watching TV and working on a puzzle in the common area. Facility has internet service and an internet access device designated for resident use. The telephone was tested and was operational during inspection. Continued on LIC809-C... Continued from LIC809C... Smoke and carbon monoxide detectors were tested and operational during inspection. Fire extinguisher was observed fully charged and was last inspected 04/2025. Emergency Disaster Plan was reviewed and updated 04/2025. Facility conducts quarterly disaster drills with the most recent drill conducted 05/2025. At approximately 1:20pm, LPA conducted file review of three (3) staff and three (3) resident files. Three (3) of three (3) staff files reviewed contained all the required documents, proof of training and proof of current First Aid and CPR certification. Three (3) of three (3) resident files reviewed contained all the required documentation. Licensee state that facility assists with coordinating medical and dental appointments as well as transportation to and from appointments when residents have the need. Medications and medication records were inspected and the logs were observed maintained in compliance with regulation. P&I was observed stored and maintained in compliance with regulation. Updated copies of the following documents are to be submitted to CCL within 30 days of this visit: LIC400 - Affidavit Regarding Client/Resident Cash Resources LIC200 - Application Requesting Fire Department Bedridden Clearance Exit interview conducted with Licensee whose signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jun 30, 2025

Type of visit: Case Management - Annual Continuation

At approximately 11:00AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to review resident and staff files for the annual inspection which began on 05/29/2024. LPA met with Administrator Maria Hernandez. At approximately 11:15AM, LPA reviewed 5 of 6 resident records and found all records contained the required documents. Medication records are thorough and contained physician's orders for each resident. At approximately 12:00PM, LPA reviewed 5 of 5 staff records and found all records contained evidence of required training. Evidence of current first aid and CPR training were current. LPA interviewed 3 staff and 2 residents during this inspection. At approximately 12:30PM, LPA reviewed the facility emergency disaster plan. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducts and documents disaster drills quarterly. Updated copies of the following documents were received during visit: LIC500- Personnel Report LIC308-Designation of Facility Responsibility Evidence of Liability Insurance No deficiencies were observed in the areas inspected, No citations were issued during today’s visit.the state’s words, verbatim · CDSS document, May 30, 2024

Type of visit: Required - 1 Year

At approximately 12:15PM, Licensing Program Analyst (LPA) Chris Arnhold made an unannounced annual required inspection of this licensed senior care facility. LPA met with Administrator Maria Hernandez. At approximately 12:30PM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are secured and not accessible. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire extinguishers inspected were charged. Smoke detectors were found to be in working order. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure. Due to time constraints, LPA will return at a later date to review resident and staff files. No citations issued during today's visit.the state’s words, verbatim · CDSS document, May 29, 2024