Aging in the Bay

Type of visit: Required - 1 Year

On 10/20/25 at 01:15 PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with administrator (ADM) and explained the purpose of the visit. LPA observed ADM has a current administrator certificate# 7032646740 which expires 12/12/26. At 2PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, clients and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizer were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 76 deg F. Hot water temperature was measured at 114 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. LPA reviewed 2 staff and 5 resident files. The following deficiencies were observed during visit: Dirty carpets with odor in the front living room and TV area Expired fire extinguishers - one fire extinguisher had unreadable old receipt and another had no reinspectiontags or receipt taped to bottom half of cylinder Lock on refrigerator door Incomplete Personnel record (LIC 500) Continued on next page, LIC 809-C Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POCs) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties. Updated copies of the following documents were obtained from administrator:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 20, 2025

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Nov 7, 2025

The facility shall be clean, safe, sanitary and in good repair at all times This requirement was not met as evidenced by dirty, odorous carpets in the front entrance living room and TV areas which posed a potential health & safety risk to residents in carethe state’s words, verbatim · CDSS document, Oct 20, 2025

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Nov 7, 2025

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic This requirement was not met as evidenced by expired fire extinguishers without re-inspection tags or current purchase receipts which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 20, 2025

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Nov 7, 2025

Sufficient food service personnel shall be employed, trained and their working hours scheduled to meet the needs of residents... This requirement was not met as evidenced by use of locking device on refrigerator which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 20, 2025

Plan of correction: By POC due date, ADM agrees to complete and submit to CCL staff re-training on residents' personal rights and having access to food in compliance with Section 87555.

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Nov 7, 2025

The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee... This requirement was not met as evidenced by incomplete personnel record (LIC500) which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 20, 2025

Type of visit: Required - 1 Year

On 9/13/24 at 01:40 PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with administrator (ADM) and explained the purpose of the visit. At 2PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, clients and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizer were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Fire extinguisher was observed fully charged and last inspected 09/15/23, Comfortable temperature is maintained at 78 deg F. Hot water temperature was measured at 111 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. LPA reviewed 2 staff and 4 client files. Updated copies of the following documents were obtained from administrator:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610D- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 13, 2024