Senior Care Comfort Living #2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Licensee, Jose Pira, Continual Administrator's Certification expires 09/28/2027 . There are currently 5 residents who reside at this home and there is 1 resident on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested 100 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. Resident 1's Admission agreement does not have correct facility name or admission date listed. LPA observed food removed from original containers into unlabeled, containers with no date. Resident 2's ambulatory status is not listed on medical assessment (both ambulatory and non ambulatory boxes checked.) Resident 2 does not have required TB test. The facility does not have detailed plan to be self reliant for 72 hours in case of disaster. The facility does not have detailed plan on assistance with administering refrigerated diabetes medication in case of disaster. The facilities Infection control plan is not documented as updated annually. The facility is removing resident medications from original bubble pack container into weekly organizer. Resident 2's Centrally stored medication record is not accurate. Licensee moved facility residents from closed facility to current facility without providing residents required written notice. The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Licensee, Jose Pira, and copy of report left at facilitythe state’s words, verbatim · CDSS document, Jun 17, 2026

The state marks this report as 8 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Shawna Doucette responded to the facility to conduct an Annual Inspection. LPA was granted entry by Licensee/Administrator Jose Pira LPA conducted a tour inside and outside of facility. Facility observed to be clean, and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Kitchen toured, appeared clean and safe for food preparation. Food supply checked. LPA observed an adequate supply of food. Resident rooms checked. Hot water measured at 106.3degrees F. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching. Fire extinguisher serviced on 05/13/2025. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Facility has a pull station fire alarm. All cleaning supplies are locked and secured in a cabinet in the garage. Medications were locked in a cabinet in the kitchen. Facility does not currently have any residents or staff. An exit interview was conducted with the Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 15, 2025

Type of visit: Prelicensing

ON 05/14/2024, Licensing Program Analyst (LPA) L. Salazar conducted a second Pre-licensing visit. LPA was greeted by Administrator and was granted entry into the facility. LPA conducted the inspection with Administrator using the Inspection Tool. A tour inside and outside the facility was conducted.Comp III was reviewed, and the following regulations were discussed: Night Supervision: 87415 Persons providing night supervision (10 p.m. to 6 a.m.) for RCFE must be available to assist in caring for residents as required. Staff must be awake for dementia diagnosed residents. Pre-Admission Appraisal: 87457 Licensee should conduct a pre-appraisal for each resident prior to resident’s admission into the facility. The appraisal for each resident must be kept on file Acceptance and Retention limitations:87455 Patients requiring 24hour, skilled nursing or immediate care in a health facility will not be accepted. Prohibited Health Conditions: 87615 Licensee cannot accept persons who require inpatient care in a health facility or skilled nursing facility or depend on others to perform all activities of daily living. Licensee cannot accept persons with conditions listed: Stage 3and 4 pressure injuries; gastrostomy tubes; naso-gastic tubes; tracheostomies; staph of other serious infection. Food Service: 87555 Menus must be written at least one week in advance. Copies of menus are served as dated and kept on file for 30 days. Modified Diets as prescribed by a person in care’s physician must be provided to that person in care. Planned activities: 87219 Licensee must provide planned activities, group interaction, social activities, physical activities. Record Keeping LIC 311 C Administrator will notify licensing and send LIC 9020 (Resident roster) when first resident is accepted. Comp III completed.the state’s words, verbatim · CDSS document, May 14, 2024

Type of visit: Prelicensing

On 05/07/24, Licensing Program Analyst (LPA) L. Salazar arrived at the facility for an announced pre licensing inspection. LPA was greeted by Licensee/Administrator and was allowed entry into the facility. LPA toured the facility inside and out with licensee. LPA entered through the front door and did observed the required postings in the entry. LPA observed the residence to be a single story, 4 bedroom/ 2 bathroom home. There is a dining room and living room observed to have adequate furnishings and lighting. All bedrooms were observed to have beds, personal lighting and chest drawers to accommodate 2 residents per room. LPA observed fire extinguisher to be new and charged with a service date of 04/2024. Smoke detectors were tested and observed to be operational. Carbon Monoxide detector was observed in the kitchen. Emergency lighting /flashlights and night lights in the hallways by the bathrooms were observed. LPA observed a adequate supply of towels. Hand washing signs observed. A supply of paper towels were observed in the bathrooms. Hot water temperature in bathroom measured at 107.4 degrees F. Non-Skid mats were not present in the shower. Grab bars were observed in resident bathroom, however, the staff / visitor bathroom, licensee will install. Kitchen observed to have supply of dishes, plates, pots and pans. Food storage and preparation areas are clear and appropriate for food preparation. Cleaning supplies and chemicals are locked in the garage. A locked cabinet in the kitchen is designated to store medications. Sharps/knives were observed in a locked drawer in the kitchen. Appliances observed to be in working order. LPA observed a 7 day supply of non-perishable food. (continued on LIC809-C) (Continued from LIC 809) First aid kit was observed. Washer and Dryer observed in the laundry room with additional storage space available in upper cabinets. Doors and passageways are clear and free from obstruction throughout the home. LPA toured the outside of the residence and observed a covered patio with a adequate outdoor seating for activities. A self-latching gate found to be working properly. There are no bodies of water on the premises. The following observed will need to be brought into compliance: Dust ceiling fans in bedrooms Touch up paint for baseboards, wall trim and bedroom door trims throughout the house, Posting of Ombudsman poster and visiting Policy Remove posters on walls from previous facility Fill in screw holes in bedrooms Paint or clean entry doorways and doors New trash can for room 101 Provide internet device for resident's telecommunications use Update the emergency disaster plan (LIC 610D) to reflect specific steps of what the facility will do in the event of an emergency disaster - specifically page 2, 4, 5. An exit interview was conducted and a copy of this report was left with licensee, whose signature confirms receipt of these documents.the state’s words, verbatim · CDSS document, May 7, 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, Mar 29, 2024