Senior Care Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 5/13/26 at approximately 1:36pm, and met with Administrator Janine Sorenson..Licensee/Administrator arrived to meet with the LPA. Facility has a fire clearance approval for 6 non-ambulatory of which 1 may be bedridden, in room #2 only. Fire extinguishers were charged as required. Facility has an approved dementia plan of operation. There is an approved hospice waiver for four (4) residents. Facility has a required infection control plan. Facility has an emergency and disaster plan as required. Facility does have a generator for emergencies if needed. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. Emergency disaster quarterly drills are conducted as required; Last emergency drills were conducted on two shifts on 4/2/26, and on one shift on 4/4/26. LPA reviewed six (6) resident files. Medications records were reviewed, and medications were found to be stored as required by regulation/HSC. LPA reviewed five (5) staff files. All staff have criminal record clearance as required. All staff have CPR and first aid certification as required. LPA reviewed required staff training, including medication training for those staff that assist resident's with medications. The LPA toured the facility with the Administrator Janine. The hot water was measured at 114. degrees Fahrenheit. The exits were free and clear of all obstructions. All exits had auditory alarms on the doors. Facility had a sufficient food supply. All medications were locked up and inaccessible to residents in care. All medications were stored appropriately per regulations/law. All disinfectants/cleaners were locked up and inaccessible to residents in care. Continued on LIC809C... The facility had sufficient linens, hygiene products, paper products, and personal protective equipment (PPE), soaps, and cleaners/disinfectants. Sufficient furnishings for resident use. The facility had sufficient lighting in resident rooms, common areas, bathrooms, and hallways. All bathrooms had grab bars, and non-skid mats/flooring. The smoke alarms and carbon monoxide detectors were working during the inspection. The facility was clean and orderly. The facility was observed to be at a comfortable temperature. LPA is requesting the following documents be updated and submitted to CCL by 6//13/26: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610 (9 page)- Emergency Disaster Plan- update if needed- submit copy Copy of Current Liability Insurance Copy of Infection Control Plan- update if needed- submit copy LIC400- Affidavit of Client Cash Resources Copy of Bond if handling cash, per LIC400 There are no deficiencies cited during today's inspection. Exit interview was conducted with Administrator Ami Kumar.the state’s words, verbatim · CDSS document, May 13, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 4/9/25 at approximately 2:00pm, and met with Administrator Janine Sorenson.. Caregivers notified Licensee/Administrator that the LPA had arrived to conduct an inspection. There currently are six (6) residents in care. LPA observed two caregivers on duty. LPA reviewed six (6) resident files. All files were complete. LPA reviewed five (5) staff files. LPA reviewed staff training. LPA reviewed staff's first aid and CPR certifications. All staff have criminal record clearance as required. Facility has a fire clearance approval for 6 non-ambulatory of which 1 may be bedridden, in room #2 only. Fire extinguishers were serviced and tagged as required. Emergency fire & disaster drills are conducted as required. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three(3)residents. Facility has a required infection control plan. Facility has an emergency and disaster plan as required. Facility does have a generator for emergencies if needed. The facility does have emergency food, water, and supplies to meet the "72 hour shelter in place" requirements. Hot water was measured at 113.3 degrees Fahrenheit. The exits were cleared and unobstructed. Food supply was sufficient. Sufficient furnishings throughout the facility. Sufficient lighting in all resident rooms, bathrooms, and common areas. Continued on LIC809C... Sufficient supply of linens, cleaners/disinfectants, and paper products. All medications were locked and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents in care. Bathrooms had grab bars and non-slip mats and/or shower flooring for resident use. LPA discussed the updated/changes in regulations with Administrator Janine Sorenson. LPA emailed the Departments PIN ASC- #24-09, regarding the regulation updates, to the Licensee/Administrator Ami Kumar and Janine Sorenson, Administrator. LPA are requesting the following documents be updated and submitted to CCL by 5/9//2025: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610 - Emergency Disaster Plan-update if needed-submit if changes Copy of Current Liability Insurance Copy of current Administrator Certificate Copy of updated Infection Control Plan- update if needed- submit if changes The following deficiency (s) was observed by the LPA during the inspection: Per LPA observation, there were two uncovered bowls of pureed food and/or what looked like soup, a plate with food not fully covered by the foil on it, and a large, uncovered blender jar filled with food to be pureed. This deficiency will be cited, 87555(b)(9) General Food Service Requirements- The following food service requirements shall apply: Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service, see LIC809D. Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator Janine Sorenson. Appeal Rights provided to the Administrator.the state’s words, verbatim · CDSS document, Apr 9, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hansen conducted an unannounced Annual inspection of facility and met with Ami Kumar, Licensee and Janine Sorenson, Administrator. Facility has 6 residents in care, 2 receiving hospice care and 5 residents with dementia diagnosis. At approximately 11:10 AM LPA & Administrator 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 residents have call buttons and motion sensors which sound in kitchen area. All notices that are required to be posted have been posted and are in a highly visible area. Facility has an approved dementia plan of operation. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in locked laundry room, hallway closet and under locked kitchen sink. Water temperature measured between 127.2 degrees F to 128.8 degrees F falling out of regulation between 105 and 120 degrees F in 5 out of 5 faucets accessible to residents in care. Licensee turned water heater down at time of visit. (see LIC809-D) There was an ample supply of cleaners, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars and non-slip floors/mats. Fire extinguisher inspected was last charged on 12/28/2023. Smoke detectors and carbon monoxide detectors were tested and found to be in working order. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure in med room off of kitchen which also contains a small refrigerator with lock for medication. Facility to ensure that approved Admissions Agreements are always posted and/or accessible to public view in the facility as per Title 22 Regulations # 87507 (e)(2) Admissions Agreement “The licensee shall conspicuously post in a location accessible to public view in the facility a complete copy of the approved admission agreement, modifications and attachments, or notice of their availability from the facility.” Continue on LIC809-C At approximately 12:30 PM, LPA reviewed 5 of 5 resident records and found 5 of 5 residents have current physician’s reports and updated care plans. 5 of 5 resident records contained current and signed admission agreements and physician’s orders on file. Hospice care plans are up to date and current. At approximately 1:50 PM, LPA review 5 of 5 staff records. 5 of 5 records contain documentation of completed training records as required. Evidence of current first aid and CPR training were observed. Staff S1 records did not contain current TB (see LIC809-D). The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 5/13/2024 at 2:30 PM. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. At approximately 12:30 PM, LPA reviewed the facility emergency disaster plan with staff. Facility has a generator to supply power during an outage. 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 quarterly disaster drills with the last disaster drill conducted on 4/15/2024. Janine Sorrenson Administrator Certificate #6039492740, expired 5/4/2024 and provided LPA confirmation of pending certificate. LPA reviewed Licensing Information System (LIS) with Licensee who stated that is corrected and updated at this time; no need to change any of the information. Appeal Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal rights provided. LPA Hansen is requesting Licensee to update and submit the following documents to CCL by 6/5/2024: LIC 308 Designation of Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changed) LIC 9020 Register of Facility /Resident’s Control of Property – Lease or Deed Copy of Administrator’s Certificate Proof of Liability Insurancethe state’s words, verbatim · CDSS document, May 13, 2024