Fine Gold Manor

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced Case Management inspection regarding a self-reported Death Report (LIC 624). LPA arrived to the facility at 10:30 AM and met with the Administrator Christina Gomez entrance interview was conducted and the reason for the visit was explained. On 12/26/2025, Community Care Licensing Division (CCLD) received a self-reported Death Report (LIC 624) pertaining to the death of Resident #1 (R1) which occurred on 12/24/2025. During an interview with the Administrator on 12/29/2025 and during the initial visit regarding this incident on 12/30/2025 the Administrator stated that R1 was found unresponsive in the dining room by facility staff after having a snack in the evening of 12/24/2025. The Administrator stated that staff observed R1 unresponsive and immediately called 911 and attempted to assist R1. The Administrator stated that staff removed food debris from R1’s mouth and began CPR. The Administrator stated that R1 was on a diabetic diet. The Administrator stated that R1 did not have any issues swallowing or with choking in the past. Interviews with facility staff confirmed that R1 was served a sandwich in the evening of 12/24/2025. LPA reviewed R1’s LIC 602 (Physician’s Report for Community Care Facilities) and observed R1’s dietary restrictions to be listed as Ground NAS CCD/CCHO Diet. LPA contacted the skilled nursing facility that had completed the LIC 602. The on-duty nurse answered the call and explained that this type of diet refers to a diet where the food must be cut into small “Ground” pieces with no added salt “NAS” in a consistent carbohydrate intake “CCD/CCHO”. LPA conducted a physical plant tour of the facility and observed the facility’s kitchen. CONTINUED ON LIC 809C. LPA observed a poster of clients who had special diets at the facility posted on the wall. LPA observed R1 to be listed under the “Diabetic Diet” section but did not observe any mention of Ground or NAS dietary restrictions for R1. On 06/25/2026 Community Care Licensing Division (CCLD) received the death certificate for R1 which listed R1’s cause of death as “Cardio Pulmonary Arrest” and “Myocardial Infarction.” No citations are being issued at this time related to R1’s death, as the cause of death appears to be of natural causes. Although, due to the facility not adhering to R1’s dietary restrictions, a citation of CCR 87555(b)(7) is being cited on today’s date (08/13/2026). Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Aug 13, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(7) · Plan of correction due date: Aug 14, 2026

87555...Food Service Requirements (b) The following...shall apply: (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement is not met as evidenced by: Based on observation, interview, and record review the Licensee did not comply with the section cited above as the facility did not adhere to R1's Ground NAS CCD/CCHO Diet which posed an immediate health risk to clients in care.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: Administrator agreed to submit a statement of understanding confirming that kitchen staff will adhere to resident's prescribed diets, that resident's prescribed diets will be accurately posted in the kitchen in a place where staff can easily view the dietary restriction list... ...Administrator agreed to submit the statement to CCLD no later than POC due date.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a continuation of the required annual visit at 09:47 AM. LPA met with facility staff who contacted the facility Administrator Christina Gomez. The Administrator arrived to the facility at 09:55 AM. Entrance interview was conducted and the reason for the visit was explained. The following was observed: RECORD REVIEW: Record review began at 10:00 AM. Resident and staff records were reviewed for documents including, but not limited to: health screening, TB test, physician's report, needs and service appraisal, consent forms, and personal rights. Four (4) resident files were reviewed. All resident files contained all required documentation and signatures. Five (5) staff files were observed. All staff files contained all required documentation and trainings. No deficiencies were observed during record review. MEDICATION REVIEW: Medication review began at 12:10 PM. Medications for five (5) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. INTERVIEWS: LPA interviewed four (4) residents. The residents interviewed stated that the staff treat them well and are attentive to their needs. No residents interviewed had concerns with the facility. LPA interviewed four (4) staff members. The staff members interviewed were knowledgeable on the resident's rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. No deficiencies were observed during today’s inspection. Exit interview conducted and copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 11:02 AM. LPA met with facility staff who contacted the facility Administrator Christina Gomez. The Administrator arrived to the facility at 11:15 AM. Entrance interview was conducted and the reason for the visit was explained. Beginning at approximately 11:20 AM the LPA, along with the facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: This includes the TV room, Activity room, hallway, and dining area. LPA observed the TV room and activity room to be clean and properly furnished at the time of the visit. These rooms contained a television, adequate seating, and activities for resident use. The hallway was observed to be clean and free from any obstructions. The hallway contained locked storage closets which contained storage for linens, cleaning chemicals, decorations, maintenance supplies, and care supplies. The dining area was observed to be equipped with adequate seating for resident use. The entryway and lobby contained all required postings. LPA observed a hallway closet to contain adequate emergency food and water supplies for the facility. The facility’s fire detection system were tested by Advance Building Protection and was certified through 03/31/2026. LPA observed the hallway to contain wall mounted fire extinguishers which were fully charged and were last serviced on 11/22/2024 and 01/18/2023 which is outside of the range required by regulation. LPA informed the Administrator who agreed to have a technician come out to service all fire extinguishers in the facility. All exits in the facility were observed to be free from any obstructions. LPA observed cameras located throughout the common areas of the facility. Continued on LIC 809C. BEDROOMS: There are sixty four (64) bedrooms in the facility; five (5) are dual occupancy resident rooms, fifty nine (59) are single occupancy resident rooms. LPA and the Administrator toured ten (10) bedrooms. All ten (10) resident rooms observed were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. LPA unannounced tested the signal alert system in two (2) resident bedrooms at 11:54 AM and at 12:23 PM and received immediate responses over the PA system from facility staff. KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA tested the water temperature in the kitchen and observed the temperature to be 109.2 degrees Fahrenheit, which is in compliance with regulation. LPA observed the kitchen to contain a wall mounted fire extinguisher which was fully charged and last serviced on 11/22/2024 which is outside of the range required by regulation. BATHROOMS: There are three (3) common resident bathrooms at the facility and each bedroom has an attached private resident bathroom. All resident bathrooms observed were clean and were equipped with nonskid surfaces. Grab bars were observed in all inspected showers and near all inspected toilets, all were properly secured. The water temperature was measured to be between 107.4 and 111.9 degrees Fahrenheit, which is in compliance with regulation. GARAGE: LPA observed the garage to contain a locked chemical storage, a locked maintenance room, various machinery rooms, and a theater which was under construction at the time of this report. LPA observed a working automatic gate at the access to the garage. LPA observed clear passageways for emergency exit use. OUTDOOR SPACE: The facility had adequate shaded seating outdoors for resident use. LPA observed all emergency exits to be clear from obstructions. LPA observed cameras located throughout the outdoor areas of the facility. Continued on LIC 809C. RECORD REVIEW: Record review began at 12:36 PM. Resident records were reviewed for documents including, but not limited to: health screening, TB test, physician's report, needs and service appraisal, consent forms, and personal rights. Six (6) resident files were reviewed. LPA observed Resident #1 (R1)’s bedroom to contain a wheelchair. Upon reviewing R1’s file LPA observed their physician report from 2024 to list R1 as “Ambulatory”. LPA observed a request form where R1 indicated that they required a wheelchair and walker. LPA informed the Administrator who stated that R1 utilizes the wheelchair on longer outings. LPA informed the Administrator that R1 was listed as “Ambulatory” but utilization of a wheelchair/walker constitutes a change in condition of R1 and a reappraisal of R1 will need to be conducted by a medical provider to determine if R1’s ambulatory status has changed since their last physician’s report. The Administrator expressed understanding and agreed to complete an updated assessment of R1 with a medical professional. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 01/23/2026. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, updated disaster plan, and current liability insurance. Due to time constraints LPA will return at a later date to conduct four (4) additional resident file reviews, staff file review, medication review, and interviews. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 10, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Trevor Bryne conducted an unannounced Case Management inspection regarding a self-reported Death Report (LIC 624). LPA arrived to the facility at 09:47 AM and met with facility staff who contacted the Administrator Christina Gomez. The Administrator arrived to the facility at 10:01 AM entrance interview conducted and the reason for the visit was explained. On 12/262025, Community Care Licensing Division (CCLD) received a self-reported Death Report (LIC 624) pertaining to the death of Resident #1 (R1) which occurred on 12/24/2025. During today’s visit between 10:01 AM and 01:00 PM, the LPA conducted a brief physical plant tour, interviewed the facility Administrator, two (2) staff members, two (2) residents, two (2) witnesses, and obtained copies of pertinent documents. No deficiencies were observed during today’s inspection. The LPA will return at a later date to conduct additional investigation/interviews. Exit interview conducted with the Administrator and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 31, 2025

Allegation investigated: Due to lack of supervision, resident physically assaulted another resident

Licensing Program Analyst (LPA) Trevor Byrne conducted a follow-up complaint visit for the above allegation. LPA arrived to the facility at 03:55 PM. LPA met with the facility staff who contacted the Administrator Christina Gomez. The Administrator arrived to the facility at 04:20 PM. Entrance interview conducted and the reason for the visit was explained. During today’s visit, the LPA delivered findings for the above allegation. Continued on LIC 9099C. Unsubstantiated The allegation of “Due to lack of supervision, resident physically assaulted another resident” alleges that due to a lack of supervision by facility staff, Resident #1 (R1) and Resident #2 (R2) got into an altercation where R2 was physically assaulted. LPA interviewed the Administrator who described the altercation that took place on 08/07/2025 at approximately 05:00 PM as happening “out of the blue.” The Administrator stated that the altercation occurred in and around Resident #3’s (R3) room. The Administrator stated that facility staff were alerted to the altercation and responded to the incident but by the time they arrived the incident had concluded. The Administrator stated that paramedics and police were contacted but no medical transport was conducted, and no charges were pressed. The Administrator stated that video of the incident was recorded by the facility’s hallway cameras, but no audio of the incident was available. The Administrator showed LPA a recording of the incident. The recording showed R1 approaching R3’s room where R2 and R3 were meeting. R1 briefly entered the room and appeared to leave before returning shortly thereafter. R1 entered R3’s room and after a brief moment R1 backed out with R2 appearing to fall out of R3’s doorway onto the floor. R2 then grabbed onto R1’s leg and began kicking R1 in the stomach repeatedly from the floor. R1 broke free from R2’s grip and began backing away while R2 got up off of the floor and retreated back into R3’s room. LPA observed the entire altercation to last approximately thirty (30) seconds. LPA interviewed R1, R2, and R3. All residents interviewed stated that facility staff responded to the incident and authorities were notified. The residents interviewed all stated that the three (3) of them were very close friends prior to the incident and often spent time hanging out together. All residents denied an altercation like this occurring previously. R1 stated that they have been offered medical attention by the facility on multiple occasions, but they have denied treatment each time it is offered. R2 initially denied treatment at the time of the altercation but has had a follow-up with their primary care physician since the incident. Interviews with Staff #1 (S1) revealed that they and staff #2 (S2) responded to the altercation as soon as they were alerted but by the time they arrived on scene the altercation had concluded. S1 and S2 ensured emergency services were contacted, notified the Administrator of the event, and stayed with residents to keep them separated and prevent further escalation. LPA reviewed the employee schedule for the date of 08/07/2025. LPA observed a total of five (5) staff members to be present at the facility at the time the altercation took place. The interview with the Administrator revealed that the facility is taking precautions to ensure another altercation between the residents does not happen. The precautions taken include staff checks on R1 approximately every two (2) hours and moving R2, with their permission, to another room on the opposite side of the facility. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Due to lack of supervision, resident physically assaulted another resident.” Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. The report was reviewed and a copy was provided.the state’s words, verbatim · CDSS document, Aug 21, 2025 · control 29-AS-20250811130435

Allegation investigated: Staff are unable to communicate with residents. Staff did not seek timely medical attention for resident. Staff are not properly notifying resident responsible parties of incidents in a timely manner. Licensee does not ensure facility is adequately staffed to meet residents needs.

Licensing Program Analyst (LPA) Trevor Byrne conducted a follow-up complaint visit for the above allegations. LPA arrived to the facility at 03:24 PM. LPA met with staff who contacted the facility Administrator Christina Gomez via telephone call. Administrator arrived to the facility at 04:02 PM. Entrance interview conducted and the reason for the visit was explained. On 05/12/2025 LPA conducted a physical plant tour to ensure there are no health and safety hazards, conducted a file review for ten (10) residents, collected copies of pertinent documents, and conducted interviews with the Administrator, one (1) witness, and seven (7) residents between 10:33 AM. and 02:00 PM. During today’s visit, between 03:30 PM and 04:05 PM the LPA conducted four (4) staff interviews and delivered findings for the above allegations. Continued on LIC 9099C. Unsubstantiated The allegation of “Staff are unable to communicate with residents.” alleges that facility staff are unable to assist residents due to them not understanding English. LPA interviewed the facility Administrator who stated that the facility always has English speaking staff on site. The Administrator stated that there are a couple of staff members who are able to understand English but are not proficient in speaking English. The Administrator confirmed that an English speaking staff member is always present with these staff while they are on shift. LPA interviewed seven (7) facility residents. All residents interviewed stated that staff are able to communicate with them and understand their needs. One (1) resident stated that if there is ever a communication misunderstanding another staff member will step in to assist. No residents interviewed have had issues receiving care due to a language barrier. LPA interviewed one (1) staff member, staff #1 (S1) who worked the overnight shift at the facility. S1 was fluent in English and understood the proper reporting procedures for incidents involving residents. LPA interviewed five (5) total staff. Four (4) staff spoke English fluently and one (1) staff was able to understand English. LPA interviewed two (2) witnesses. One (1) witness interviewed, witness #1 (W1) reported “minor” communication issues with staff but reported that staff are mostly consistent. Witness #2 (W2) did not report having issues communicating with staff. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff are unable to communicate with residents.” Therefore, the allegation is deemed Unsubstantiated at this time. The allegation of “Staff did not seek timely medical attention for resident.” alleges that the facility did not seek medical attention for a resident after a medical emergency. LPA interviewed seven (7) facility residents. All residents interviewed reported that staff are quick to respond to calls for assistance. One (1) resident interviewed, resident #1 (R1) reported that the facility is quick to give medical attention during an emergency. R1 also reported that 911 was called during a recent incident right away. LPA interviewed the Administrator who stated that all facility staff are trained to respond to incidents involving residents immediately. The Administrator informed LPA that staff are notified of incidents via the facility-wide intercom system. LPA interviewed five (5) total staff. All staff interviewed stated that they are trained by the facility Administrator to respond to incidents immediately. LPA interviewed two (2) witnesses. Both witnesses interviewed had no concerns with the facility seeking timely medical attention for the residents. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of “Staff did not seek timely medical attention for resident.” Therefore, the allegation is deemed Unsubstantiated at this time. The allegation of “Staff are not properly notifying resident responsible parties of incidents in a timely manner.” alleges that the facility did not notify a resident’s responsible party of an incident involving the resident in a timely manner. LPA interviewed three (3) residents who have a responsible party to be notified in case of emergencies. Two (2) of the residents confirmed that their responsible party was made aware of incidents that occurred recently as the incidents were occurring. LPA interviewed two (2) witnesses. Both witnesses stated that they were informed of incidents involving residents as they were occurring. No witnesses had concerns about the facility not notifying them of incidents. LPA interviewed the Administrator who confirmed that front desk staff are trained to notify the responsible parties of residents in the event of an incident occurring. The Administrator stated that if the staff do not receive an answer from the responsible party a message is left, and follow-up calls are made. The Administrator showed LPA a sign located at the front desk that read "ALL STAFF When residents are transferred to hospital family members (Or next of kin) needs to be notified right away.” Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff are not properly notifying resident responsible parties of incidents in a timely manner.” Therefore, the allegation is deemed Unsubstantiated at this time. The allegation of “Licensee does not ensure facility is adequately staffed to meet resident’s needs.” alleges that the facility is not adequately staffed throughout the day to meet the resident’s needs. LPA reviewed the facility’s staff schedule. The staff schedule reported on average approximately eleven (11) staff members on shift during the day four (4) staff on shift in the evening and two (2) staff members on shift during the night. LPA interviewed seven (7) residents. All residents interviewed reported that there are enough staff present at the facility to care for their needs. No residents interviewed had concerns about inadequate staff coverage. LPA interviewed the Administrator who stated that during the day there are three (3) caregivers, two (2) housekeepers, one (1) receptionist, the activity director, the Administrator, a cook, a dishwasher, Maintenance personnel, and an assistant for a total of approximately 12 staff on shift. The Administrator stated that there are three (3) staff members on shift overnight with an additional two (2) staff on call approximately five (5) minutes away from the facility. LPA interviewed five (5) total staff. No staff interviewed reported being overworked or short staffed at the facility. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Licensee does not ensure facility is adequately staffed to meet resident’s needs.” Therefore, the allegation is deemed Unsubstantiated at this time. No deficiencies were cited during today’s inspection. A copy of the report was printed and exit interview was conducted.the state’s words, verbatim · CDSS document, Jun 3, 2025 · control 29-AS-20250505112701

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Trevor Byrne conducted a follow-up pre-licensing visit to the above noted facility at 09:11 AM. The LPA met with Administrator, Christina Gomez entrance interview conducted and the reason for the visit was explained. This is a change of ownership application. During the initial pre-licensing inspection conducted on 12/06/2024 LPA Byrne conducted a full physical plant tour, measured the water temperature in twenty-one (21) resident bathrooms, and observed the facility’s food supplies. During today’s visit LPA Byrne conducted a physical plant tour, measured the hot water temperature in ten (10) Resident bathrooms and one (1) common bathroom, observed window screens in ten (10) resident bedrooms and common areas, and observed the facility’s food and water supplies. All bathrooms observed had their hot water temperature measured between 108.7 - 120 degrees Fahrenheit which is in compliance with regulation. All window screens observed were in good repair and were free of rips and tears. LPA observed the facility to have adequate emergency food and water supplies. Additionally, LPA observed a sufficient supply of perishable and non-perishable foods. All foods observed were within their expiration dates. The Component Three (COMP III) orientation was completed with the facility Administrator Christina Gomez during the initial 12/06/2024 pre-licensing inspection. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.the state’s words, verbatim · CDSS document, Jan 9, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Trevor Byrne conducted a pre-licensing visit to the above noted facility. The LPA met with Administrator, Christina Gomez. This is a change of ownership application. A Hospice Waiver has been requested. The facility is three (3) stories. At 09:10 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for one-hundred (100) non-ambulatory and ambulatory residents. The facility has sixty-one (61) private resident bedrooms, and two (2) shared room(s), Room numbers nine (9) and fifty (50). All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. Rooms # twenty-six (26) and sixty-three (63) were observed to contain ripped screens. There are four (4) bathrooms in the hallway. Each resident bedroom is equipped with an attached private bathroom. The resident bathrooms have a shower with non-skid materials. All toilets and showers have appropriately secured grab bars. The hot water temperature was tested in the bathrooms and the kitchen. The kitchen water was measured to be 127.4 degrees Fahrenheit, LPA observed warning signs near the kitchen sinks. Continued on LIC 809C. Resident and staff records are stored securely in the Administrator’s office. Medications are centrally stored in a locked medication room on the first floor of the facility. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. First aid kits are located throughout the facility. Kitchen knives are stored securely in the kitchen. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at thirty-two degrees Fahrenheit (32*F). The supply of nonperishable and perishable food is adequate. At 09:16 AM LPA observed the facility refrigerator to contain moldy strawberries. At 09:34 AM LPA observed the facility emergency food supply to contain eleven (11) cans of expired peaches. There are no pesticides, poisons, or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in locked closets located throughout the facility’s hallway. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, games and activity supplies in the facility’s activity rooms. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight were made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. There are no fireplaces located at the facility. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility smoke alarm system is hard wired. There are pull stations throughout the facility. The smoke detector and carbon monoxide detectors were tested at 11:56 AM and functioned properly during the time of visit. There are ten (10) fire extinguishers throughout the facility. All are fully charged and do not exceed the expiration date. Continued on LIC 809C. Hot water was tested in each bathroom, which included the resident bathrooms and any common bathrooms, in addition to the kitchen; the hot water ranged between 97.3 and 131.7 degrees Fahrenheit which is outside of the range allowed by regulations. The laundry area is located in the hallway on the first floor of the facility. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored by residents in their own rooms. Extra incontinence supplies are stored in the facility basement. There are functioning telephones on the premises. The emergency exiting plans/sketch are posted throughout the facility’s hallways. The emergency telephone numbers are posted in the lobby next to the facility elevator along with other required postings. The exterior passageways were clean and clear of any obstructions. There are covered balconies attached to each resident room. There is a patio located in the center of the facility with adequate seating for resident use. The garage gate is moved automatically. There are not any bodies of water on the premises at the present time. The garage is accessible from the facility. The Component Three (COMP III) presentation was conducted with the facility Administrator Christina Gomez at the time of the visit. The following items, and a follow-up pre-licensing inspection, must be corrected prior to licensure. Submit proof of corrections, along with a copy of this report, to LPA Byrne so that your application may be completed. 87303(e)(2) - (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). 87303(c) - (c) All window screens shall be clean and maintained in good repair. 87555(b)(8) - (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained.the state’s words, verbatim · CDSS document, Dec 6, 2024

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Oct 8, 2024