St. Anthony's Residential Care Home

Type of visit: Case Management - Legal/Non-compliance

On 8/27/2026 at 12:30 pm, Licensing Program Analyst (LPA) Y. Brown conducted a Case Management Legal/Non-compliance visit. Upon entry, the LPA explained the purpose of the visit to Licensee Josephine Wilson. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During visit, LPA observed that resident one (R1), R2 and R4 were observed to be at the facility. LPA and Licensee discussed the construction timeline, resident accommodations and the inspection timeline. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, and garage. LPA observed that phase one was completed and phase two is in the process of being completed. Exit interview conducted with Josephine Wilson and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 27, 2026

Type of visit: Case Management - Legal/Non-compliance

On 7/1/2026 at 11:30 am, Licensing Program Analyst (LPA) Y. Brown conducted a Case Management Legal/Non-compliance visit. Upon entry, the LPA explained the purpose of the visit to Licensee Josephine Wilson. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During visit, LPA observed that resident one (R1), R2, R3, R4, and R5 were observed to be at the facility. LPA and Licensee discussed the construction timeline, resident accommodations and the inspection timeline. Licensee stated that the City of San Leandro has been doing consecutive inspection visits. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, and garage. Exit interview conducted with Josephine Wilson and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 1, 2026

Type of visit: Case Management - Legal/Non-compliance

On 5/5/2026 at 1:00 PM, Licensing Program Analyst (LPA) Y. Brown conducted a Case Management Legal/Non-compliance visit. Upon entry, the LPA explained the purpose of the visit to Licensee Josephine Wilson. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During visit, LPA observed that resident one (R1), R2, R3, R4, and R5 were observed to be at the facility. LPA and Licensee discussed the construction timeline, resident accommodations and the inspection timeline. Licensee stated that the City of San Leandro has been doing consecutive inspection visits. Exit interview conducted with Josephine Wilson and a copy of this report provided.the state’s words, verbatim · CDSS document, May 5, 2026

Type of visit: Case Management - Legal/Non-compliance

On 4/23/2026 at 10:30 PM, Licensing Program Analyst (LPA) Y. Brown conducted a Case Management Legal/Non-compliance visit. Upon entry, the LPA explained the purpose of the visit to Licensee Josephine Wilson. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During visit, LPA observed that resident one (R1), R2, R3, R4, and R5 were observed to be at the facility. LPA and Licensee discussed the construction timeline, resident accommodations and the inspection timeline. Licensee stated that the City of San Leandro has been doing consecutive inspection visits. Exit interview conducted with Josephine Wilson and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 23, 2026

Type of visit: Required - 1 Year

On 4/1/2026 at 9:15 AM, Licensing Program Analyst (LPA) Y. Brown conducted an unannounced annual 1-year required inspection. LPA met with Licensee/Administrator Josephine Wilson and explained the purpose of the visit. The administrator currently holds a certificate (#7010647740) that expires on 8/14/2027. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. All indoor passageways are kept free of obstruction. A comfortable temperature for clients is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hot water temperature in the facilities shared resident restroom was measured at 110.5 degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for residents. Smoke detectors and carbon monoxide combination were in operating condition during visit. Fire extinguisher was last purchased on 4/1/2026. First aid kit was observed to be complete. LPA reviewed three (3) staff and five (5) resident records. LPA reviewed a sample of medication. Emergency disaster plan was last reviewed and updated on 3/8/2026. Emergency disaster drill was last conducted on 3/8/2026. Continued on LIC809C. Continued from LIC809. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 04/8/2026: LIC610D: Emergency disaster plan LIC500: (Personnel Record) LIC 308 Designation of Administrative Responsibility No deficiencies cited during the visit. Exit interview conducted with Josephine and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 1, 2026

Type of visit: Case Management - Legal/Non-compliance

On 4/1/2026 at 12:30 PM, Licensing Program Analyst (LPA) Y. Brown conducted a Case Management Legal/Non-compliance visit. Upon entry, the LPA explained the purpose of the visit to Licensee Josephine Wilson. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During visit, LPA observed that resident one (R1), R2, R3, R4, and R5 were observed to be at the facility. LPA and Licensee discussed the update on resident accommodations while construction is active in the facility and the timeline. Licensee stated that the proposed plan was approved and The City of San Leandro granted the facility a building permit. Exit interview conducted with Josephine Wilson and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 1, 2026

Type of visit: Case Management - Legal/Non-compliance

On 1/6/2026 at 11:30 PM, Licensing Program Analysts (LPAs) Y. Brown and A. Gomez conducted a Case Management Legal/Non-compliance visit. Upon entry, the LPA explained the purpose of the visit to Licensee Josephine Wilson. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During visit, LPAs observed that resident one (R1), R2, R3, R4, and R5 were observed to be at the facility. LPAs and Licensee discussed the update on the relocation of the residents. LPAs and Licensee discussed the update on the building permit to be issued by the City of San Leandro and the update on the current construction. The Licensee updated the LPAs on the issuance of a City of San Leandro building permit. Exit interview conducted with Josephine Wilson and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 6, 2026

Type of visit: Case Management - Legal/Non-compliance

On 11/18/2025 at 12:30 PM, Licensing Program Analyst (LPA) Y. Brown conducted a Case Management Legal/Non-compliance visit. Upon entry, the LPA explained the purpose of the visit to Caregiver Boots Kahmann. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. During visit, LPA observed that resident one (R1), R3 and R4 in their bedroom. R2 and R5 were observed in the dining room having lunch. LPA and caregiver discussed the update on the construction. Licensee Josephine Wilson gave authorization to Boots Kahmann, Caregiver to sign todays report. Exit interview conducted with Boots Kahmann and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 18, 2025

Type of visit: Case Management - Legal/Non-compliance

On 10/30/2025 at 12:30 PM, Licensing Program Analysts (LPAs) Y. Brown and A. Gomez conducted a Case Management Legal/Non-compliance visit. Upon entry, the LPA explained the purpose of the visit to Licensee Josephine Wilson. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During visit, LPAs observed that resident one (R1), R2, R3, R4, and R5 in their bedroom. LPAs and Licensee discussed the update on the relocation of the residents. The Licensee stated that they have contacted the residents responsible parties for updates on placement. Licensee stated that the families of the residents were not actively working on relocation of any of the residents. The LPAs and Licensee discussed the update on the building permit to be issued by the City of San Leandro and for the contractor to replace one exterior window with a French door and to install 2 or 3 ramps. The Licensee updated the LPAs on the issuance of a City of San Leandro building permit. The Licensee stated that the architect said that the earliest it would be issued would be 12 to 15 business days from 10/16/2025. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 30, 2025

Type of visit: Case Management - Health Checks

On 10/20/2025 at 1:45 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced for this Case Management - Health Checks visit. Upon entry into the facility, the LPA explained the purpose of the visit to Licensee / Administrator Josephine Wilson. During the visit, the LPA observed residents R1, R2, R3, R4, and R5 in their bedroom. The LPA interviewed Resident R4. R4 stated that their care was excellent. R4 stated that they and their family member who also lives at the facility were very happy living there. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During the visit, the Licensee provided an update on the relocation of the residents. The Licensee stated that they have contacted the residents responsible parties for updates on placement and that none of the families were actively working on relocation of any of the residents. The Licensee updated the LPA on the issuance of a City of San Leandro building permit. She said that the architect said that the earliest it would be issued would be 12 to 15 business days from today. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 20, 2025

Type of visit: Case Management - Legal/Non-compliance

On 10/10/2025 at 11:30 AM, Licensing Program Analyst (LPA) Y. Brown conducted a Case Management Legal/Non-compliance visit. Upon entry, the LPA explained the purpose of the visit to Licensee Josephine Wilson. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During the visit, LPA and Licensee discussed the update on the relocation of the residents. Licensee stated that they have contacted the residents responsible parties for updates on placement. LPA confirmed the census at the facility. LPA and Licensee discussed the update on the building permit to be issued by the City of San Leandro and for the contractor to replace one exterior window with a French door and to install 2 or 3 ramps. Licensee stated that they have been in contact with the architect/contractor to expedite the building permit process. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 10, 2025

Type of visit: Case Management - Legal/Non-compliance

On 10/2/2025, at 9:15 AM, Licensing Program Analysts (LPAs) Y. Brown and J. Sampair arrived unannounced for this Case Management Legal/Non-compliance visit to deliver the letter dated 10/2/2025 to the Licensee Josephine Wilson. Upon entry, Licensee Josephine Wilson was notified of the purpose of the visit. During this visit, the LPAs delivered the letter to Licensee Josephine Wilson. No citations issued during this visit. Exit interview conducted with Licensee and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 2, 2025

Type of visit: Case Management - Legal/Non-compliance

On 10/2/2025 at 9:15 AM, Licensing Program Analyst (LPAs) Y. Brown and J. Sampair conducted a Case Management Legal/Non-compliance visit. Upon entry, the LPAs explained the purpose of the visit to Licensee Josephine Wilson. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During the visit, LPAs and Licensee discussed the update on the relocation of the residents and the update on the building permit to be issued by the City of San Leandro and for the contractor to replace one exterior window with a French door and to install 2 or 3 ramps. Licensee stated that they have been working with the residents responsible parties to relocate the residents. LPAs confirmed the census at the facility. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 2, 2025

Type of visit: Case Management - Legal/Non-compliance

On 9/19/2025 at 9:30 AM, Licensing Program Analyst (LPAs) Y. Brown and J. Sampair conducted a case management-legal non-compliance visit and met with Licensee Josephine Wilson and LPAs explained the purpose of the visit. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During the visit, LPAs and Licensee discussed the update on the relocation of the residents and the update on the building permit to be issued by the City of San Leandro and for the contractor to replace one exterior window with a French door and to install 2 or 3 ramps. Licensee stated that they have been working with the residents responsible parties to relocate the residents. LPAs confirmed the census at the facility. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 19, 2025

Type of visit: Case Management - Legal/Non-compliance

On 9/11/2025 at 12:45 PM, Licensing Program Analyst (LPA) Y. Brown conducted a case management-legal non-compliance visit and met with Licensee Josephine Wilson and LPA explained the purpose of the visit. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During the visit, LPA and Licensee discussed the update on the relocation of the residents and the update on the building permit to be issued by the City of San Leandro and for the contractor to replace one exterior window with a French door and to install 2 or 3 ramps. Licensee stated that they have been working with the residents responsible parties to relocate the residents. LPA contacted the responsibly parties of the residents and confirmed the census at the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 11, 2025

Type of visit: Case Management - Legal/Non-compliance

On 9/4/2025 at 10:30 AM, Licensing Program Analyst (LPA) Y. Brown conducted a case management-legal non-compliance visit and met with Licensee Josephine Wilson and LPA explained the purpose of the visit. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During the visit, LPA and Licensee discussed the update on the relocation of the residents and the update on the building permit to be issued by the City of San Leandro and for the contractor to replace one exterior window with a French door and to install 2 or 3 ramps. Licensee stated that they have been working with the residents responsible parties to relocate the residents. LPA reviewed resident records and confirmed the census at the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 4, 2025

Type of visit: Case Management - Legal/Non-compliance

On 8/22/2025 at 10:45 AM, Licensing Program Analysts (LPAs) Y. Brown and J. Sampair conducted a case management-legal non-compliance visit and met with Licensee Josephine Wilson and LPAs explained the purpose of the visit. This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on 8/15/2025. During the visit, LPAs observed an updated LIC500 that lists out the designated staff members that are on duty for the fire watch. The LIC500 details the fire watch being conducted 24 hour 7 day a week and assigned to a staff whose sole duty is to monitor the facility for internal and external hazards until residents are safely relocated by close of business 8/18/2025. LPAs also contacted the responsible parties of the residents and discussed the plans for relocation and fire watch plan. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 22, 2025

Type of visit: Case Management - Other

On 08/08/2025, at 11:30 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced at the facility for a Case Management visit. Upon entry, the LPA stated the purpose of the visit to Licensee Josephine Wilson. The San Leandro Fire Prevention Code Compliance Office denied the Licensee’s request on 8/6/2025 to change the fire clearance from 6 ambulatory to 6 nonambulatory residents. 6 nonambulatory persons reside at the facility, the purpose of this visit was to ensure that the Licensee makes the proper placement of those 6 residents while the appropriate changes are being made to the physical plant to accommodate the 6 nonambulatory residents. The Licensee stated that she will properly place residents during the time it will take for the permit to be issued by the City of San Leandro and for the contractor to replace one exterior window with a French door and to install 2 or 3 ramps. She stated that she has begun the calls to the families and the facilities for the residents to live in temporarily. No citations were issued during this visit. Exit interview conducted with Licensee and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 8, 2025

Type of visit: Office

On 05/06/2025 at 10:45 AM, an Informal Meeting was held via video conference with Administrator/Licensee Josephine Wilson. The purpose of this Informal Meeting was to discuss serious and reoccurring deficiencies during 2024 and 2025. Attendees: Harpreet Humpal - Licensing Program Manager Yasamin Brown - Licensing Program Analyst James Sampair - Licensing Program Analyst Josephine Wilson - Administrator/ Licensee Issues discussed during the meeting: Misrepresentation: facility license for wrong facility displayed Fire Clearance: 6 of 6 residents are non-ambulatory in a ambulatory only facility Recurring deficiencies: unlocked disinfectants, unlocked Medication, and unlocked knives. Creating a temporary plan for safely caring for non-ambulatory residents while the Licensee is completing the process of being licensed for non-ambulatory residents. Hiring a backup Administrator if Ms. Wilson prefers to focus on care giving rather than administrator duties. Exit interview conducted and a copy of this report provided to Licensee via Emailthe state’s words, verbatim · CDSS document, May 6, 2025

Type of visit: Case Management - Annual Continuation

On 04/08/2024 at 8:30 am Licensing Program Analysts (LPAs) Yasamin Brown and James Sampair arrived unannounced to do an annual inspection. LPAs met with Administrator Josephine Wilson and explained the purpose of the visit. The LPAs reviewed the records of 5 residents and 3 staff members. One (1) Type A citations and six (6) Type B citations issued during visit. One (1) Civil Penalty was assessed for $500. Civil Penalties totaling $500 have been assessed today for failure to meet POC due dates for the deficiencies above. Facility is subject to ongoing daily civil penalties until proof of corrected deficiencies have been sent to Community Care Licensing (CCL). Deficiencies are cited from Title 22 California Code of Regulations (see 809D's). Failure to submit proof of correction may result in additional civil penalty. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 8, 2025

Type of visit: POC

On 04/04/2025, at 8:30 AM, Licensing Program Analysts (LPAs) James Sampair and Yasamin Brown arrived unannounced to conduct a Plan of Correction (POC) inspection. Upon entering the facility, the LPAs explained the purpose of visit to Licensee Josephine Wilson. On 3/28/2025, LPAs James Sampair and Yasamin Brown conducted a Required - 1 Year inspection during which 2 A-Type and 3 B-Type deficiencies were cited. All 5 deficiencies were cleared during the visit. No citations issued. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 8, 2025

Type of visit: Required - 1 Year

On 03/28/2025 at 11:00 am Licensing Program Analysts (LPAs) Yasamin Brown and James Sampair arrived unannounced to do an annual inspection. LPAs meet with Administrator Josephine Wilson and explained the purpose of the visit. LPAs inspected the facility inside out. LPAs inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. LPAs observed the room temperature 78 degrees Fahrenheit he water temperature at 106.2 degrees. Continued on LIC809-C.. ...Continued from LIC808. LPAs observed the following deficiencies: At 11:30AM,LPAs observed facility having all non-ambulatory residents. At 11:37AM, LPAs observed that Licensee did not have the current license posted. At 12:05PM, LPAs observed unlocked cabinets with sharp knives inside. LPAs also observed unlocked outdoor cabinet with a gallon of Deadweed brew, Resolve stain carpet cleaner, and two gallons of open paint. At 12:15PM, LPAs observed that 0/6 staff members did not have there CPR/First Aid Certificates updated. At 12:30, LPAs observed during record review that residents did not have records for medical assessment. Two (2) A type citations and three (3) B type citations issued during visit. Two (2) Civil Penalties issued during visit. Civil Penalties totaling $750 have been assessed today for failure to meet POC due dates for the deficiencies above. Facility is subject to ongoing daily civil penalties until proof of corrected deficiencies have been sent to Community Care Licensing (CCL). Deficiencies are cited from Title 22 California Code of Regulations (see 809D's). Failure to submit proof of correction may result in additional civil penalty. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 28, 2025

Type of visit: Required - 1 Year

On 05/24/24 at 9:00 am Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with Administrator Josephine Wilson and explained the purpose of the visit. LPA inspected the facility inside out. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. The facility has a mitigation plan. Fire extinguishers were observed fully charge and tags showed serviced 01/26/2024. At 10:02 am LPA reviewed 6 residents records. At 10:45 am, LPA reviewed 2 staff records and 2 of 2 were fingerprint cleared and associated to the facility. The following deficiency was observed during the visit: LPA observed medication left out on table LPA observed chemical cleaners left out in bathroom and around the house repeat violation LPA observed bugs flying around the in kitchen LPA observed a mouse in garage repeat violation Continued on LIC809-C... ... Continued from LIC 809 LPA observed staff living in shed LPA observed bike lock on exit gate LPA observed knifes in unlocked drawer repeat violation LPA observed medication cabinet unlocked A civil penalty is being assessed today for $3000 for all repeat violations {$1000 per violation x 3} The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, May 24, 2024

Type of visit: Case Management - Annual Continuation

On 1/27/2024 at 9:30am, Licensing Program Analyst (LPA) Carol Fowler returned to continue the 1-Year Required inspection that was started on 1/26/2024. LPA met with Caregiver, Bootsanson Flores. LPA informed the reason for visit. Chris Wilson Manager, arrived at approximately 10:15am. LPA toured facility for corrections made, and completed reports. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jan 27, 2024

Type of visit: Required - 1 Year

On 1/26/2024 at 9:30am, Licensing Program Analysts (LPAs) Carol Fowler and Tonica Syess-Gibson conducted an unannounced 1-Year Required inspection. LPAs met with Bootsanson Flores, Caregiver, and explained the purpose of the visit. Chris Wilson, Facility Manager arrived at 11:15am. The Administrator currently holds a certificate (#6036411740) that expired on 08/14/2023 which is in the process of being renewed. The facility’s fire clearance was approved for six (6) ambulatory residents. LPA toured the facility with Caregiver including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of six (6) total bedrooms, and three (3) bathrooms. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 109.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was missing service tag. Emergency Disaster Plan was posted. First aid kit was observed to be complete. Facility did not have staff files available for review and resident files were all incomplete. Continued on LIC809C. LPA observed the following deficiencies: · At 9:50am, LPAs observed Refrigerator leaking and seal in the freezer area lose. · At 9:56am, LPAs observed scissors on the kitchen counter. · At 9:58am, LPAs observed a knife block with 11 knives and 1 pair of scissors on the kitchen counter. · At 9:59am, LPAs hardwood floor cleaner, syringes, glass cleaner underneath the kitchen sink unlocked. · At 10:03am, LPAs observed medication in an unlocked drawer in the kitchen, goof off and a knife. · At 10:06am, LPAs observed medication cabinet unlocked with bottles of vitamins and medication, which also had a lighter. · At 10:08am, LPAs observed Fire Extinguisher was not tagged with service tag. · At 10:09am, LPAs observed paint, poly stain in a unlocked cabinet and fire place prong on the fire place in a common family room. · At 10:10am, LPAs observed 2 drills, cough medication, centrally stored medications in an unlocked cabinet, Lysol, resolve air freshener all located in an unlocked office. · At 10:14am, LPAs observed scissors and medication (ointment) unlocked in located in resident room #2. · At 10:15am, LPAs observed ointment and eye drops in resident room #3. · At 10:22am, LPAs observed unlocked laundry room door with Lysol, Ajax, Clorox wipes, laundry detergent and fabric softener in an unlocked cabinet. · At 10:27am, LPAs observed wire cutters, eye drops, and a knife in room #6. · At 10:30am, LPAs observed bathtub and shower floor with stains. Continued on LIC809C. Continued from LIC809C. · At 10:36am, LPAs observed unlocked shed on the side yard with paint and power tools. · At 10:37am, LPAs observed damaged window screens in the side/back yard. · At 10:38am, LPAs observed unlocked swimming pool gate. · At 10:39am, LPAs observed a chain saw, paint and a ladder on the side yard located on a table. · At 10:40am, LPAs observed a shed being used as living quarters for staff in the back yard. · At 11:06am, LPAs during record review observed facility Manager not associated to the facility. · At 11:09am, LPAs observed resident records are incomplete. · At 11:10am, LPAs during record review observed staff files not available for review. · At 11:17am, LPAs during record review observed emergency disaster drill documents not available. · At 11:58am, LPAs observed an odor in the garage. · At 12:05am, LPAs observed a knife located in the china cabinet in the dining area. LPA requested the following documents to be submitted to CCLD by 2/09/2024. · Resident Roster · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan (9 pages) · Liability Insurance continue on LIC 809C continue from LIC 809C The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Annual Inspection will be continued at a later date.the state’s words, verbatim · CDSS document, Jan 26, 2024

The state marks this report as 18 pages; the online copy we transcribed has 14. You can request the full file from the county licensing office.