Ohana Care 4

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by staff. Brigette Fisk and Ryan Fisk, Administrators, arrived shortly after and met with LPA. There are six (6) residents at the facility and there is two (2) residents receiving hospice services currently. The facility is a one-story house with an attached garage. The facility has six resident bedrooms currently assigned to be private. There is also one staff bedroom in use by the awake night staff. LPA observed residents in the dining room having breakfast. LPA accompanied by staff began the tour of the inside and outside of the facility. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in a freezer in the garage. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage cabinet located in the laundry unit. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA observed the first aid kit. LPA inspected the facility bathrooms and LPA measured the hot water temperature which measured 114.8 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in the laundry unit. LPA Continued on LIC809-C observed the laundry unit is kept locked and had a keypad lock on the doorknob. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which have sufficient lighting to ensure safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke detectors/carbon monoxide detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there are shaded seating areas for residents’ enjoyment in the front yard as well as the backyard of the facility. LPA observed a fire extinguisher with service date of September 24, 2025, charged and mounted in the kitchen. Fire drills are conducted every three months, LPA verified fire drill logs are kept and last drill was conducted May 22, 2026. LPA began reviewing records. LPA reviewed three resident records. All the required documentation was present and current in the residents’ files reviewed. LPA reviewed three employee records. All employees present have a criminal record clearance and are associated to the facility. LPA observed records reviewed have a current First Aid certificate. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrator, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jul 20, 2026

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Brigitte Fisk was notified of the visit via telephone and arrived later to assist. There are currently six residents in care, four of which are receiving hospice care at this time. LPA observed residents relaxing in their respective bedrooms or in the facility's common living areas. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with an attached garage, with six private bedrooms, two shared and one en-suite bathrooms. Bedrooms appear clean and sanitary. All four hospice residents are observed to have beds equipped with full-length bed rails. Hospice plans of care reviewed. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are equipped with grab bars and slip mats. Hot water temperature measured at 119F in multiple bathrooms equipped with faucets used for personal grooming. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage are verified to be secured in the locked laundry area. CONTINUED ON FORM LIC809-C CONTINUED FROM LIC809 Fire extinguisher present is charged with up-to-date maintenance tag. Carbon monoxide and smoke detectors were found to be present and operational. The garage is secured and used for the storage of supplies and food. Emergency food and water supplies verified to be present. LPA and facility staff toured the outside of the facility. LPA observed multiple shaded outdoor seating areas with furniture for resident use. The identified route of egress is free of clutter and obstructions. There is one self-latching gate on the side of the premises. There are no bodies of water on the premises. Egress alarms are in use on exit doors, however facility does not utilize locked perimeters or delayed egress. LPA reviewed six resident records which included all necessary components. LPA reviewed resident medication records and prescription orders for all residents with no discrepancies observed. One resident is observed to have been assessed as bedridden upon admission but is currently able to reposition and attends meals and activities in the common living areas. Type B citation issued as the change in condition has not been documented at this time. LPA reviewed staff records for two staff members present during the visit. CPR training, initial and annual training reviewed for 2024 and 2025. Disaster drills are conducted quarterly and documented. Staff members are verified to be background cleared and associated to the licensed location. Based on the observation conducted during the present visit, one type B deficiency is being cited per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights was provided.the state’s words, verbatim · CDSS document, Jul 3, 2025

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPA was greeted and granted entry by facility caregiving staff after explaining the purpose of the visit. Facility administrator Ryan Fisk was notified by telephone and arrived shortly afterwards to assist. During the inspection, LPA and facility staff conducted a tour of the physical plant and observed the following: The facility is a one story home with six private bedrooms and one staff room in addition to the facility's common living areas and four bathrooms, two of which are en-suite. All resident bedrooms have the required furnishings. LPA observed all beds have linens and blankets. There are currently five residents admitted to the facility with two residents receiving hospice care. Residents are observed to be clean and appear well taken care of. Bathrooms faucets and toilets were operational. Water temperature was verified to be within acceptable range. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Fire drills are conducted quarterly. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required. Combined smoke and carbon monoxide detectors tested operational. Fire extinguisher present are observed to be fully charged with up-to-date maintenance. Medication, sharp items and cleaning supplies were confirmed to be inaccessible throughout the physical plant. The medication central storage was also observed to be secure and reviewed for accuracy during the visit. LPA reviewed five resident files and two staff files. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 26, 2024