Routine inspection·December 14, 2023

On 12/14/2023 at 2:15PM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Keith Mauer and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory residents. LPA toured facility with Keith including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 75 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 106.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 01/06/2023. Emergency Disaster Plan was last posted on 01/13/2023 . First aid kit was observed to be complete. LIC 809-C Continued.... LIC809 Continued.... At 3:00PM, LPA reviewed 5 residents records. At 4:30PM, LPA reviewed 6 staff records and 1 out of 6 have current first aid training and associated to the facility. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 2:32PM LPA observed Lactulose Solution and Metamucil unlocked in lower kitchen cabinet At 2:36PM LPA observed Emergen-C unlocked in upper kitchen cabinet At 2:42PM LPA observed Clorox Wipes unlocked on kitchen counter At 2:45PM LPA observed Tide, Fabuloso, Clorox Bleach, floor cleaner unlocked in unlocked garage At 3:05PM LPA observed ladder, wood planks and screen door located on outside grounds in backyard Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 12/21/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Exit interview conducted. Appeal Rights and a copy of this report provided.