Routine inspection·May 1, 2024

On this day at 2:00 p.m., Licensing Program Analyst (LPA) Delmundo conducted an unannounced annual inspection. LPA met with Roselyn Chand, acting administrator, and informed the reason for visit. LPA requested for copy of updated LIC9282 Infection Control Plan which LPA received on 4/23/24. Another updated LIC9282 is provided by acting administrator on this day, LPA inspected the facility inside out with the acting administrator. LPA inspected the main building (West Wing); Azalea, Garden and Peralta Cottages. LPA randomly selected residents rooms in the West Wing and cottages for inspection. LPA also inspected the living room, dining area, kitchen, bathrooms, toilets, shower room and yard. There's adequate food supplies of perishables good for 2 days and non-perishables good for 7 days. Facility uses mechanical means of cleaning/rinsing dishes and utensils. Kitchen staff check and keep record of freezers and refrigerators temperatures which were observed within Regulations range. Facility has smoke detectors that were tested, and observed functional. Hot water temperature in one of the ensuite bathrooms in the West Wing was tested, and measured at 108 degrees Fahrenheit. Fire extinguishers were checked, observed fully charge with tags showed serviced 2/27/24. LPA interviewed 2 residents. Facility does not handle residents' cash resources. LPA observed the following: -at 2:55 p.m., trash can in West Wing resident's bathroom without lid. -at 3:45 p.m., fire place in the West Wing living room not secured. -facility does not have a certified administrator. Former administrator last day at the facility was 11/2023. ....continued on 809C Page 2 -disaster drill records not readily available for review. - no carbon monoxide detectors in the West Wing, Azalea, Peralta Acting administrator to submit updated copies of the following documents by May 15, 2024: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan 4. $3M Liability Insurance certificate Due to time constraint, LPA will come back to continue the inspection. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates and any repeat violation within 12 month period may result in civil penalty. Deficiencies and plan, and proof of corrections were discussed with the acting administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form, and copy of this report provided.