Leisure Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 10:02AM. The LPA met with the Administrator Michelle Maurer and informed them of the reason for the visit. Entrance interview conducted. Beginning at 10:39AM, the LPA and Staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed knives stored inaccessible in a locked cabinet. Kitchen appliances were clean and in operable condition. The facility had a sufficient supply of perishable and non-perishable food. Food in the refrigerator and freezer were observed to be properly stored with labels and dates. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. A fireplace was observed in the living room that was screened and inoperable. Required postings were observed in the hallways. The facility maintained a comfortable temperature throughout the visit. Report Continued on LIC 809-C BEDROOMS/RESTROOMS: There were five (5) total bedrooms: one (1) shared and four (4) private rooms. Four (4) bedrooms had a direct exit to the outside and the facility approved for six (6) bedridden residents. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens were stored in the shared restroom. There were two (2) total restrooms in the facility: one (1) private and one (1) shared. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hygiene products were secured in each restroom. Hot water was tested and measured at 112.1 degrees F which is within the required range per regulation. OUTDOOR AREA: The rear yard had shaded patio areas equipped with furniture in good condition for resident and visitor use. Exits and passageways were free of obstructions. There was one (1) emergency side exit with a self-latching gate. The facility had a garage that was secured and only accessible near the entryway. The garage contained general storage, laundry machines in good condition, hygiene supplies, extra food, emergency food and water, and a staff room. RECORDS: Record review began at 11:16AM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. A fire extinguisher was observed and was purchased on 08/14/2025. Emergency disaster drills are conducted monthly, with the last documented drill on 01/03/2026. Smoke and carbon monoxide detectors were tested at 12:01PM and were operational. Report Continued on LIC 809-C MEDICATIONS: Medication review began at 12:06PM. Medications were centrally stored and kept inaccessible in a medication closet. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates and were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Feb 5, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 01:36PM. LPA was greeted at the door by staff and Administrator Michelle Maurer who arrived at 02:13PM. Entrance interview conducted. At 01:42PM, the LPA along with staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPA inspected the kitchen/food service area at 01:42PM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and nonperishable food. Food labels were inspected and checked for expiration dates and food labels had expiration date clearly marked. Knives and chemicals were locked inaccessible in kitchen drawer and under-the-sink cabinet. Fire extinguisher was fully charged and last purchased 09/01/2024. BEDROOMS: There are five (5) bedrooms total of which four (4) are for single resident-use and one (1) is for shared resident-use. LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. At 01:50PM, LPA observed the window screen in Bedroom #4 unable to fully close. RESTROOMS: There are two (2) restrooms. Restrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The restrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. LPA measured hot water between 01:49PM - 01:51PM and were between 107.6 - 113.4 degrees F, which is within the required range. Report Continued on LIC 809-C COMMON AREAS: At the time of the visit, living room and dining room furniture were observed to be in good condition. The facility maintained a comfortable temperature of 72 degrees F. At 01:54PM, smoke detector(s) and carbon monoxide detector were tested and were operational at the time of the visit. Auditory exit alarms were functioning at the time of the visit. LPA observed required postings throughout the common spaces. OUTDOOR AREA/GARAGE: LPA observed the back patio which has a covered area for resident use. There is a self-closing and self-latching gate on the side of the house designated for an emergency exit. Passageways were free and clear from obstruction. There are no bodies of water on the premises. LPA observed the locked garage to contain an additional refrigerator/freezer, emergency food, additional supplies, and a washer/dryer. MEDICATION REVIEW: At 01:56PM, LPA reviewed medications for two (2) residents. Medications are centrally stored and locked in the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. RECORD REVIEW: Beginning at 02:12PM, LPA reviewed six (6) out of six (6) resident files and three (3) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All resident and personnel files were in order. During the visit, LPA obtained copies of liability insurance, LIC 500, and resident roster. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency drills are conducted quarterly as is required, with the last drill conducted on 01/06/2025. The following deficiency was observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. Administrator was informed that failure to correct deficiency may result in civil penalties. Exit interview was conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 28, 2025

Type of visit: Required - 1 Year

At 10:10 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by House Manager Blaire Soriano and informed them of the reason for the visit. Administrator Michelle Maurer was unable to be present during the visit and authorized Blaire Soriano to review and sign the report. At 10:26 a.m. the LPA conducted a tour of the physical plant with the House Manager to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of five (5) resident bedrooms, and two (2) restrooms. The LPA observed one (1) fire extinguisher which was fully charged and last purchased on 09/21/2023. All smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings in the hallway near the entrance area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Kitchen: At 10:32 a.m. the kitchen appeared clean and the appliances and fixtures functional. The LPA observed a sufficient amount of perishable and non-perishable food at the facility. Food is prepared based on the menu. Snacks and beverages are always available for the residents. Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding. The LPA observed bedrooms #2, #3 and #4 with exit doors obstructed. Bedroom #2 had a nightstand and a chair obstructing the exit door to the outside. Bedroom #3 had a dresser and a portable ventilator obstructing the exit to the outside, and a nightstand obstructing the door between bedroom #3 and bedroom #4. The door between bedroom #3 and #4 is an exiting door for bedroom #4. Report will continue on LIC809-C. Bathrooms: The LPA observed all bathrooms, properly supplied, and had functional fixtures. The LPA observed grab bars and non-skid floors in all bathrooms. At 10:44 a.m. water temperature in the outside restroom was measured at 128.9 degrees Fahrenheit. At 10:58 a.m. water temperature in the resident’s restroom in room #1 was measured at 127.2 degrees Fahrenheit. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in the living room, which is covered with a screen. The garage: The LPA observed the garage where the washer and dryer are held. The garage is used as storage. The garage is locked. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water on the premises. Record Review: At 11:07 a.m. a review of facility files was initiated. Facility records are stored in a locked closet. The LPA observed documentation of Infection Control, Disaster prevention and last fire drill (conducted on 02/05/2023). The LPA obtained Client Roster, Staff Roster, and Insurance Liability. The LPA reviewed five (5) out of six (6) resident files. Files were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. The Appraisal/Needs and Services Plans (ANS) for one resident was noted with two dates, the LPA could not verify if the ANS was from 2023 or 2022, however the House Manager confirmed it was dated 2023. Otherwise, all resident records were in order. The LPA reviewed five (5) of seven (7) staff files. Staff files and Administrator’s file were reviewed for, but not limited to personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. The LPA identified that one (1) of five (5) staff did not have TB test results on file. Otherwise, all staff records were in order. Interviews: The LPA conducted two (2) resident Interviews and two (2) staff interviews. No immediate concerns were voiced. Medications: At 2:30 p.m. a medications review was initiated for two out of five residents and the following was observed. The medications were stored in a locked closet and inaccessible to the residents. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. During Resident #1 and Resident #2 ‘s (R1, R2) audit, the LPA observed PRN medication for both residents, however the LPA did not observed a PRN authorization letter from their physicians. 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 and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 23, 2024