Gordon Manor

On 3/5/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Portia Gaddi, Administrator and explained the purpose of the visit. LPA toured the physical plant. This is a 1-story building with 54 bedrooms and 52 bathrooms, a living room, dining room, kitchen, and outdoor space/backyard. All bedrooms had the required furniture and sufficient lighting. No accessible bodies of water or hazards were observed in hallways or the backyard. The facility's fire alarms and Carbon Monoxide detector were observed to be in working order. According to the Administrator, the fire alarms are directly connected to the Redwood City fire department. The facility's first aid kit was observed to have all required items. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. The facility's hot water was measured between the required 105-120 degrees Fahrenheit. All sharp objects, poisons, and detergents were observed to be locked and in-accessible to persons in care. LPA reviewed 5 resident records and 6 staff files. All were observed to be complete. LPA received the following records at the facility: Current Liability insurance Updated LIC 500 Emergency/Disaster Plan No deficiencies cited during the visit. The Annual will be completed at a later date. An exit interview was conducted and a copy of the report provided.

On 1/30/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 8:45 AM to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Portia Gaddi, Administrator and explained the purpose of the visit. LPA toured the physical plant. This is a 1-story building with 54 bedrooms and 52 bathrooms, a living room, dining room, kitchen, and outdoor space/backyard. All bedrooms had the required furniture and sufficient lighting. No accessible bodies of water or hazards were observed in hallways or the backyard. The facility's fire alarms and Carbon Monoxide detector were observed to be in working order. According to the Administrator, the fire alarms are directly connected to the Redwood City fire department. The facility's first aid kit was observed to have all required items. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. The facility's hot water was measured between the required 105-120 degrees Fahrenheit. All sharp objects, poisons, and detergents were observed to be locked and in-accessible to persons in care. LPA reviewed 7 resident records and 5 staff files. All were observed to be complete. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. LPA received the following records at the facility: Current Liability insurance Relias training transcripts Emergency/Disaster drill documentation 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA requested the following documents be sent to the Department by 2/7/2025: Current LIC 500 No deficiencies were cited during today's visit. This report was reviewed with Portia Gaddi, Administrator and a copy of the report left at the facility.

On October 3, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 8:30 AM to conduct a Case Management visit in regards to an incident that occurred on 9/14/2024 and reported by the licensed facility, in which a resident had an un-witnessed fall. LPA Calandra was greeted by Portia Gaddi, Administrator and explained the purpose of the facility. John Solano, Infection Preventionist, arrived later during the visit. LPA Calandra gathered and reviewed the LIC 602, care plan, etc. and conducted interviews. Based on review of documents and interviews, LPA Calandra found that staff responded in a timely manner, notified the appropriate parties and updated R1's needs and services plan. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Portia Gaddi, Administrator and John Solano, Infection Preventionist and a copy of the report left at the facility.

On 03/01/2024 Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced 1 year annual inspection visit. LPA met with administrator Porita Gaddi and explained the purpose of today's visit. LPA toured the facility inside and outside with the administrator. Emergency routes This is a single level facility. While touring the facility LPA tested the water in resident rooms. Water is tested at 111F. Resident rooms 102, 104, 109, 114, 120, and 301 are observed and are well maintained with the required furniture and lighting. Residents have an adequate amount of linens and incontinence supplies, incidental supplies, as well as PPE as needed stored in appropriate storage areas around the facility. Multiple fire extinguishers are stationed around the facility. LPA observed that they are charged and within the appropriate range. Tagged inspection is dated as 03/27/2023. Carbon monoxide detectors and smoke detector are present through out the facility. Facility is hardwired with smoke detectors and facility is fully equipped with sprinklers through out the facility. Two resident shower rooms are observed to be in good repair and contain the required non-skid floor mats and shower chairs for resident use. Incidental supplies such as shampoo, conditioner, and soap are available for resident use. LPA observed the kitchen of the facility. 7 day non-perishable food supply and 2 day fresh food supply is observed as in place. Kitchen appliances such as washing area, stove, and range are in working order. Prescribed food, modified, and diet plans are posted in the kitchen for staff reference. Continue on next page... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Page 2 - 809C Medications are stored and inaccessible in a locked medication room. Medications are stored and controlled medications are double locked in place. Medications are reviewed to be in place and accurately marked. Medication administration record is observed as current for clients reviewed including centrally stored medication log. First aid items are observed in medication room as well as plentiful and in place. Additional first aid kits are available outside of medication room. On site laundry is available and functioning per observations made. 5 staff records are reviewed. All staff has criminal record clearance and are associated with the facility. Based on record reviews, TB tests, training, CPR/First Aid cards, and personnel files are current. 5 resident records are checked and all are complete and updated. Disaster drill is last conducted on 11/16/2023 per records reviewed. Drills conducted vary on type of emergency based on record reviewed. Administrator is current and observed to be expiring on 04/23/2025. The following updated items are requested to be sent to the Department by 03/08/2024 : • LIC610D Emergency Disaster Plan • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report • Updated administrator certificate • LIC9020 Client Roster • Certificate of Liability Insurance • Proof of control of property • Surety bond with expiration date Report is reviewed with Portia. No citations issued.

On this day at 1015hrs, Licensing Program Analysts (LPA) Jaime Vad conducted an unannounced pre-licensing inspection visit. LPA met with administrator Portia Gaddi and explained purpose of today's inspection LPA toured the facility's building and grounds. Entire facility is hardwired with smoke detectors, fire sprinkler system, and fire panel. Fire panel last inspected on 2/15/2022 and had passed all inspections conducted by Bay Alarm. Carbon Monoxide detector is observed and tested as fully functional. Fire extinguishers are last inspected on 1/12/2021 but all observed extinguishers are fully charged and available for use. Outside rear of facility contains a large backyard area for residents and family to visit. There are no fountains or bodies of water present. Side entrance gate is closed and not locked. Residents do not have access to this gate or the adjacent side street of the facility. Facility is equipped with Wander Guard system. Inspected rooms contain pull cords and button call system for resident use in bedroom and bathrooms. LPA inspected the kitchen and dining room areas. Dining room area is observed as clean and in order. Range and stove are clean and operable. Food preparation areas observed as organized and clean. Modified diet plans for residents are posted for staff reference. Ansul fire suppression system last inspected on 9/2/2021. Range venting hood is observed as clean. Both fresh food and frozen food supplies are inspected and observed as in place. Dry goods/emergency food supplies are in place. Kitchen receives deliveries of these good via Sysco regularly. LPA observed the central medication room. Facility does not use a medication cart. A lock pad is observed for access to the medication room and at time of inspection LPA observed two staff in this room. Refrigerator for medications is in place. Narcotics are locked and secured. Resident records are in place and observed in binders located within. Complete first aid kit is located in the medication room. Through out the facility there are additional first aid kits available. LPA observed the facility spare linens as in place and plentiful. Facility's PPE supply is observed as in place and ready for use. Cleaning supply closet is observed as locked and secured. Cleaning cart is used but locked and secured when not in use. Laundry room is observed as fully operational. LPA observed resident rooms observed are occupied and contain all the required furniture for resident use. Ambient room temperatures are comfortable through out the facility. Pull cord system and push button system is observed. Water temperatures were taken are within range. Room 225 water temp read at 110F, Room 208 water temp read at 120F, Room 121 water temp read at 117F, Room 115 water temp read at 117F. Facility is in compliance with Title 22 regulations. No citations are issued. Report is reviewed with administrator.