Golden Years Residential Care

Type of visit: Case Management - Other

On 12/29/2025 at 9:20AM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced Case Management visit to the facility regarding the control of property. LPA met with staff, Rosie Gaxiola, stated the purpose of the visit and gained entry into the residence. The Administrator, Iren Creighton was contacted via telephone and arrived later during the visit. There are currently four (4) residents in care. LPA observed three (3) staff during the visit. LPA completed a brief tour of the residence, reviewed resident and staff records and conducted a health and safety check of residents in care. No deficiencies were cited during this visit. An exit interview was conducted where this report LIC809 was discussed and a copy was provided to Administrator, Iren Creighton.the state’s words, verbatim · CDSS document, Dec 29, 2025

Type of visit: Required - 1 Year

On 11/07/2025, Licensing Program Analyst (LPA) Renese Howell-Small arrived unannounced to conduct the required annual visit to the facility. LPA met with Administrator Iren Creighton. LPA introduced self, stated the purpose of the visit and gained entry to the residence. LPA was informed that there are currently 5 residents in care, three (3) bedridden, one (1) ambulatory and one (1) non-ambulatory. The facility has 6 bedrooms, 4 bathrooms, kitchen, dining area, living room, office, laundry, attached garage and backyard. LPA completed a walk through of facility, review of records and medication audit. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 70 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 118 degrees Fahrenheit. The facility is equipped with operational smoke detectors, charged fire extinguishers and first aid kit. Posters such as; the personal rights, emergency disaster plan, CCLD complaint poster and ombudsman were posted in a common area. Cleaning supplies, toxins and other dangerous items were kept locked and inaccessible to residents. There was a designated storage space for resident/staff files. Medications were observed to be locked and inaccessible to residents. There is no swimming pool, firearms or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for residents in care. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, side gate with self-latching handle on the left side of the house that leads into the backyard. Record Review: LPA reviewed staff and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA reviewed resident files for admission agreements, updated physician reports, and needs and services plans. LPA observed one (1) staff without First Aid/CPR certification. A deficiency was cited. LPA observed three (3) bedridden residents in care, licensee and fire clearance approval is for for two (2) bedridden. A deficiency was cited and a civil penalty was assessed. Five (5) deficiencies were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102 and Appeal Rights were discussed and copies were provided to Administrator Iren Creighton.the state’s words, verbatim · CDSS document, Nov 7, 2025

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 12/06/2024, Licensing Program Analyst (LPA) Renese Howell-Small arrived unannounced to conduct the required annual visit to the facility. LPA met with Administrator Iren Creighton. LPA introduced self, stated the purpose of the visit and gained entry to the residence. LPA was informed that there are currently 5 residents in care, two (2) bedridden and (3) non-ambulatory. The facility has 6 bedrooms, 4 bathrooms, kitchen, dining area, living room, office, laundry, attached garage and backyard. LPA completed a walk through of facility, review of records and medication audit. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 77 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 115 degrees Fahrenheit. The facility is equipped with operational smoke detectors, charged fire extinguishers and first aid kit. LPA did not observe an identifiable carbon monoxide detector. A deficiency was cited. Posters such as; the personal rights, emergency disaster plan, CCLD complaint poster and ombudsman were posted in a common area. Cleaning supplies, toxins and other dangerous items were kept locked and inaccessible to residents. LPA observed a pair of scissors and knives to be in unlocked kitchen drawers. A deficiency was cited. There was a designated storage space for resident/staff files. Medications were observed to be locked and inaccessible to residents. LPA observed two (2) resident files without physician's orders for medication. A deficiency will be cited. There is no swimming pool, firearms or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for residents in care. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, side gate with self-latching handle on the left side of the house that leads into the backyard. Record Review: LPA reviewed staff and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA reviewed resident files for admission agreements, updated physician reports, and needs and services plans. LPA observed two (2) staff without First Aid/CPR certification and three (3) staff without physician's reports and tuberculosis clearance. A deficiency was cited. Five deficiencies were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102 and Appeal Rights were discussed and copies were provided to Adminisrator Iren Creighton.the state’s words, verbatim · CDSS document, Dec 6, 2024

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Staff consume liquor while on shift. Staff do not have fingerprint clearance. Staff lock facility doors to prevent residents from leaving. Staff insert suppositories to residents in care. Staff did not complete required trainings. Staff facility records are falsified. Staff did not maintain resident records. Residents are not provided proper food service.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with House Manager Megaswati Siby and explained the purpose of the visit. The Administrator Irene Creignton was contacted regarding today’s visit. The investigation consisted of staff interviews, resident interviews, record review and facility tour. LPA Rico conducted 4 staff interviews and 3 resident interviews. For the allegation, Staff consume liquor while on shift. During staff interviews 4 out of the 4 staff stated they have not witness someone drink liquor on the shift. During resident interviews 3 out of the 6 residents stated they have not witnessed a staff drink liquor. Unsubstantiated For the allegation, Staff do not have fingerprint clearance.During staff interviews 4 out of the 4 staff stated they have fingerprint clearance. During record review, LPA Rico verify the photo identification matched the clearance letter. For the allegation, Staff lock facility doors to prevent residents from leaving.During staff interviews 4 out of the 4 staff stated they have locked facility doors and have not locked residents inside their bedrooms. In addition, 3 out of the 6 residents stated they have not been locked inside the facility. For the allegation, Staff insert suppositories to residents in care. During staff interviews 4 out of the 4 staff stated they have not insert suppositories to residents in care. 3 out of the 4 staff stated that only hospice nurses can provide suppositories to residents, not caregivers. For the allegation, Staff did not complete required training's. During staff interviews, 4 out of the 4 staff stated they have completed their training's. During record review LPA verify all staff members were provided with training's. For the allegation, Staff facility records are falsified. During staff interviews 4 out of the 4 staff stated they have not falsified facility records and have not alternated residents’ documents. During record review, LPA verify staff signatures matched facility documents. For the allegation, Staff did not maintain resident records. 4 out of the staff stated the facility has maintain resident records. During record review, LPA observed residents residents records maintain at the facility. For the allegation, Residents are not provided proper food service. During staff interviews, 4 out of the 4 staff stated they provided proper food service for residents in care. In addition, 4 out of the 4 staff stated they provided breakfast, lunch, dinner, and snacks in between. During resident interviews, 3 out of the 6 residents stated they receive proper food services. During facility tour, LPA observed facility menu and food supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days at the facility. Based on the evidence found during the investigation, the eight (8) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.An exit interview was conducted, and this report (LIC9099) was discussed and provided to House Manager Megaswati Siby.the state’s words, verbatim · CDSS document, Nov 22, 2024 · control 56-AS-20241121084941

Allegation investigated: Staff did not ensure resident’s diapering needs were met. Staff did not inform resident’s physician of resident’s change of condition. Staff did not provide adequate medication assistance to residents in care. Staff refuse to call an ambulance for residents in care. Staff threatened residents in care. Staff did not ensure sufficient food items were available at the facility for residents in care.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with House Manager Megaswati Siby and explained the purpose of the visit. The Administrator Irene Creignton was contacted regarding today’s visit. The investigation consisted of staff interviews, resident interviews, record review and facility tour. LPA Rico conducted 4 staff interviews and 3 resident interviews. For the allegation, Staff did not ensure resident’s diapering needs were met. During staff interviews, 4 out of the 4 staff stated they change their residents every two hours, or as needed. During residents’ interviews 3 out of the 6 residents stated staff members change their diapers but were unable to provided how often their diapers are changed. Unsubstantiated For the allegation, Staff did not inform resident’s physician of resident’s change of condition. During staff interviews, 4 out of the 4 staff stated residents’ physician are contacted for change of condition and their responsible party. In addition, 3 out of the 4 staff stated for emergencies changes they will call the paramedics. For the allegation, Staff did not provide adequate medication assistance to residents in care.During staff interviews, 4 out of the 4 staff stated they assist residents with medications and follow physician order. During resident interviews 3 out of the 6 residents stated they receive their medication. LPA Rico verify medication were dispense properly and documentation matched current medications. For the allegation, Staff refuse to call an ambulance for residents in care. During staff interviews, 4 out of the 4 staff stated they have not refused to call the ambulance. In addition, 4 out of the 4 staff stated they will also contact the responsible party and notified hospice. During residents’ interviews, 3 out of the 6 residents stated they are allowed to call 911 and allowed to seek medical attention when needed. For the allegation, Staff threatened residents in care .During staff interviews, 4 out of the 4 staff stated they have not threatened a resident in care and have not witness other staff threatened their residents. During residents’ interviews, 3 out of the 6 residents stated they have not been threatened by staff and feel safe at the facility. For the allegation, Staff did not ensure sufficient food items were available at the facility for residents in care. During staff interviews, 4 out of the 4 staff stated they have sufficient food supplies for residents in care. In addition, 3 out of the 4 staff stated the Administrator will order food deliveries through the week. During facility tour, LPA observed sufficient food supplies for all residents. Based on the evidence found during the investigation, the six (6) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to House Manager Megaswati Siby.the state’s words, verbatim · CDSS document, Nov 22, 2024 · control 56-AS-20241121084941

Allegation investigated: Staff did not prevent residents from engaging in inappropriate interactions. Staff yelled at residents in care. Staff did not assist residents that sustained falls. Staff do not have a fire evacuation plan at the facility. Staff do not have an infection control plan at the facility. Staff are not following reporting requirements. Staff left residents unattended.

Licensing Program Analysts (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with House Manager Megaswati Siby and explained the purpose of the visit. The Administrator Irene Creignton was contacted regarding today’s visit. The investigation consisted of staff interviews, resident interviews, record review and facility tour. For the allegation, Staff did not prevent residents from engaging in inappropriate interactions. During staff interviews, 4 out of the 4 staff stated all residents do not engage in inappropriate interactions because majority of the residents prefer to stay in their rooms, during activities residents get along, and the facility has two to three caregivers per shift to provide care and supervision. During residents’ interviews, 3 out of the 6 residents stated they have not been touched or felt uncomfortable by other residents. Unsubstantiated For the allegation, Staff yelled at residents in care. During staff interviews, 4 out of the 4 staff stated they have not yelled at their residents. 4 out of the 4 staff stated they have not witnessed a staff member yell at their resident. During resident interviews, 3 out of the 6 residents stated they have not been yelled by staff and feel safe at the facility. For the allegation, Staff did not assist residents that sustained falls. During staff interviews, 4 out of the 4 staff stated they are trained to assist residents with falls and will assist if a resident has a fall. During record review, LPA verified staff have received training to assist residents. For the allegation, Staff do not have a fire evacuation plan at the facility. During staff interviews 4 out of the 4 staff stated the facility has a fire evacuation plan at the facility. During record review, LPA observed facility’s fire evacuation plan. For the allegation, Staff do not have an infection control plan at the facility. During staff interviews, 2 out of the 4 staff stated the facility has an infection control plan. During record review, LPA observed facility’s infection control plan. For the allegation, Staff are not following reporting requirements. During staff interviews, 4 out of the 4 staff they follow reporting requirements. 3 out of the 4 staff stated they will notify the Administrator, family members and hospice. The Administrator stated they are responsible to submit Special Incident Reports to Community Care Licensing. For the allegation, Staff left residents unattended. During staff interviews 4 out of the 4 staff stated they have not left the residents unattended. 3 out of the 6 staff stated they have not been left alone at the facility. Based on the evidence found during the investigation, the seven (7) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to House Manager Megaswati Siby.the state’s words, verbatim · CDSS document, Nov 22, 2024 · control 56-AS-20241121084941

Allegation investigated: Staff did not ensure that resident was adequately fed. Staff isolated resident in their room. Staff did not ensure that resident's oral hygiene needs were met.

Licensing Program Analyst (LPA) Anna Fannell conducted an unannounced visit to this facility for the purpose of initiating the investigation of and delivering findings for the above allegations. LPA met with care staff Rosie Gaxiola who was advised of the purpose of visit. The investigation consisted of interviews with relevant parties, and review of pertinent records. LPA was unable to interview Resident (R1). Allegation 1: Staff (S1) did not ensure that R1 was adequately fed. Interviews with R1 representative revealed that they witnessed S1 provide food to R1 but would not provide assistance in feeding R1. Records revealed that R1 need maximum assistance with activities of daily living (ADLs). Interview with Administrator George Ene revealed that R1 was refusing to eat and was combative. However, records revealed that R1 was provided a solution for their behavior. Records also revealed that S1 was educated to assist R1 with eating. This allegation is substantiated. Allegation 2: S1 isolated resident in their room. LPA interviewed R1 representative who stated that R1's door was closed when they arrived to visit. Records revealed that R1's bedroom door was closed when R1 is visited by other witnesses. This allegation is therefore substantiated. Substantiated Allegation 3: Staff did not ensure that resident's oral hygiene needs were met. Witness interviewed reveal that they observed R1's gums to be bleeding. Records revealed that R1 was instructed to provide oral care to R1. This allegation is therefore substantiated. A complaint finding that the allegation is SUBSTANTIATED means that the allegation/s is/are valid as the preponderance of the evidence standard has been met. Refer to LIC809-D for deficiencies cited. An exit interview was conducted telephonically with Administrator Iren Creighton where this report, LIC809-D, and appeal rights were discussed.the state’s words, verbatim · CDSS document, Apr 10, 2024 · control 56-AS-20240403141835

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(4) · Plan of correction due date: Apr 16, 2024

(f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating... This requirement was not met as evidenced by: Interviews and records reviewed revealed that R1 needed maximum assistance with ADLs, and although food was provided, assistance while R1 was eating was not provided as observed by witnesses. This poses as a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 10, 2024

Plan of correction: Licensee shall read the CCR section cited, 87464, and provide a statement of understanding of the regulation. Licensee shall submit proof of correction no later than end of POC day.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(b)(2) · Plan of correction due date: Apr 16, 2024

(b) In addition to the requirements as specified in Section 87208...the plan of operation shall address the needs of residents with dementia, including: (2) Safety measures to address behaviors such as wandering, aggressive behavior... This requirement was not met as evidenced by: Interviews and records reviewed revealed that R1 had behaviors commonly seen in persons with Dementia and staff would keep R1 in their room with their door closed to address these behaviors. This poses as a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 10, 2024

Plan of correction: Licensee shall review and re-evaluate their Dementia Care Plan. Licensee shall provide proof of review/acknowledgement and, as needed, provide a copy of the update Dementia Care Plan to the Regional Office no later than end of POC day.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(1) · Plan of correction due date: Apr 16, 2024

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care...(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Interviews and records reviewed revealed that R1's gums were observed bleeding from poor oral care. This poses as a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 10, 2024

Plan of correction: Licensee shall read the CCR section cited, 87465, and provide a statement of understanding of the regulation. Licensee shall submit proof of correction no later than end of POC day.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Anna Fannell conducted an unannounced visit to this facility for the purpose of initiating the investigation of and delivering findings on complaint control number: 56-AS-20240403141835. LPA met with care staff Rosie Gaxiola who was advised of the purpose of visit. On 10/31/2023, LPA was informed by Licensee George Ene that the facility plans to have a change in administrator and a change of ownership. Administrator Alex Popescu was informed that the facility license is non transferable. During today's visit, LPA phoned co-administrator Iren Creighton that the facility has not received a new application for the new ownership. A technical violation was discussed telephonically with Administrator Iren Creighton and copy of the entirety of this report was provided to facility representative.the state’s words, verbatim · CDSS document, Apr 10, 2024

Type of visit: POC

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility as a proof of correction visit for a deficiency issued on the 01/17/24. LPA met with administrator who was informed of the reason for the visit. During today's visit, LPA met with and spoke with Highland Fire Prevention who verified that the former staff room adjacent to the kitchen has been cleared as a resident room. A Letter of Deficiency Citation Cleared is issued today. No deficiency was issued during today's visit. An exit interview was conducted where this report was discussed with Mr. Vermani.the state’s words, verbatim · CDSS document, Jan 29, 2024

Allegation investigated: Licensee does not ensure staff are able to communicate with residents in care. Licensee does not ensure staff possess knowledge of good nutrition, food preparation and, menu planning. Staff yelled at residents in care. Staff speaks inappropriately in front of residents. Staff did not ensure resident was accorded personal privacy while in care.

Licensing Program Analysts (LPAs) Anna Bueno and Bianca Wolcott conducted an unannounced visit to the facility to initiate the investigation of the above mentioned allegations and deliver findings. LPAs identified themselves to Staff 1 (S1) and Staff 2 (2) who were informed of the reason for today’s visit. S1 notified administrator Iren Creighton of LPA's visit. The investigation included interviews with relevant parties, made facility observations, and reviewed records. Allegation 1: Licensee does not ensure staff are able to communicate with residents in care. LPAs observed S1 and S2 on shift. LPAs interviewed residents who stated that they are able to communicate their needs to staff. LPAs interviewed S1 and S2 who gave adequate responses to LPAs. Allegation 2: Licensee does not ensure staff possess knowledge of good nutrition, food preparation and, menu planning. Resident interviews revealed that staff provide nutritious meals. LPAs observed various fresh and frozen nutritive food items, such as green vegetables, potatoes, dairy, and meat. Interview wit h S1 revealed that some residents have food restrictions that they follow and that S2 only serves meals. S1 interview found that Unsubstantiated S1 and other staff prepare meals and that some meals are prepared early then frozen to be reheated on days that only S2 is working. Allegation 3: Staff yelled at residents in care. Interviews with residents revealed that staff do not yell at them nor have residents heard other staff yell at other residents. Staff interviews deny yelling at residents and have not observed other staff yell at other residents. LPAs observed S1 and S2 raise their voice when speaking with some residents due to residents being hard of hearing. Witness (W1) interview deny hearing staff yell at residents. Allegation 4: Staff speaks inappropriately in front of residents. Resident interviews deny that staff spoke inappropriately or use improper language towards residents. Staff interviews deny speaking ill to residents or observing any staff speak inappropriately to residents. W1 interviewed deny hearing staff speak inappropriately. Allegation 5: Staff did not ensure resident was accorded personal privacy while in care. LPAs observed that Room 1 is a shared bedroom with a divider in the middle of the room. LPAs observed that the facility has cameras in common areas. Interview with W1 state that staff appeared to be passing through facility common areas without pausing or stopping and denied that staff stayed in the same area with W1. Staff interviews deny recording or taking photos of any residents. Based on the information revealed during the investigation, these allegations are therefore unsubstantiated. A finding of UNSUBSTANTIATED means, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted with and a copy of this report was provided to Rosie Gaxiola.the state’s words, verbatim · CDSS document, Jan 17, 2024 · control 56-AS-20240108114146

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Anna Bueno annd Bianca Wolcott conducted an unannounced visit to the facility for the investigation of complaint number: 56-AS-20240108114146. LPAs met with staff who were informed of the reason for the visit. During today's visit, LPAs interviewed relevant parties, made facility observations, and reviewed records. It was observed that Resident 1 is located in a room that is labeled as a staff room. This pose as a potential health and safety risk to resident in care. Refer to LIC 809D for deficiency cited. Technical advisory was provided for additional concerns during today's visit. LPAs phoned Licensee and discussed the concern. An exit interview was conducted where this report, LIC809-D, and appeal rights were discussed with and provided to Rosie Gaxiola.the state’s words, verbatim · CDSS document, Jan 17, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87202(a) · Plan of correction due date: Jan 19, 2024

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshall. This requirement was not met as evidenced by: Based on LPA observations and Staff interviews, Resident 1 was observed in a room next to the kitchen labeled as staff room. This pose as a potential health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Jan 17, 2024

Plan of correction: Licensee shall relocate Resident 1 to a resident room approved by the Fire Marshal. Licensee shall provide proof of correction no later than end of POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Anna Bueno & Bianca Wolcott arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility caregiver with LPA identification and business card. LPA spoke in person with administrator. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. LPAs observe the facility to be clean and in good repair. The home is maintained at a comfortable temperature for the residents. Lighting is sufficient for safety and comfort. Water temperature measured within range. Grab bars, non-slip mats are present in the restrooms. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. Fire extinguishers are charged, mounted and dated 10/26/23. All outdoor and indoor passageways are free of obstruction. Night lights and emergency lighting is present. A locked area is provided for medications and sharp objects. There is a telephone working at this location. The LIC 610E, emergency disaster plan is maintained. The facility has a current written definitive plan of operation. The facility is maintained in conformity with the regulations adopted by the state fire marshal. The facility does not handle resident money. Personnel Records/Training/and Staffing-. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. Resident Records/Incident Reports/Personal Rights/Residents with Special Needs/Incidental Medical and Dental- LPA began review of resident records. Four (4) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed Resident 1 (R1) physician's report is not current. This poses a potential health and safety risk to residents in care. Resident Rights are posted in the facility and a copy is signed on file. Food Service- LPAs were present during the lunch time meal. The meal is adequate to meet the nutritional needs of the residents. Food prep areas are clean and organized. Food supply meets the requirement of one week supply of nonperishable and 2-day supply of perishables food on hand. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. While reviewing medication and medication records, LPAs observed medications in medication cups. This poses a potential health and safety risk to residents in care. Two client interviews were conducted. Two staff interview was conducted. Based on the information received during this visit today, the following deficiency is being cited per Title 22, Division 6 of The California Code of Regulations. This report was reviewed with and a copy provided to the facility representative. Appeal Rights were also provided at the time of the exit interview.the state’s words, verbatim · CDSS document, Nov 9, 2023