Routine inspection·November 27, 2023

Licensing Program Analyst (LPA) A. Gomez and Licensing Program Manager (LPM) Y Flores-Larios arrived unannounced to conduct 1-Year Annual Required visit on this date starting at 9:30am. LPA was greeted by Executive Director (ED), Jasmine Seiffert. Health and Wellness Director Cheyenne Flores arrived at approximately 11:00AM during the tour. LPA and LPM toured facility with Executive Director including but not limited to random residents rooms, kitchen, common area and dining area. There were no accessible bodies of water. Hallways and passages were free of obstruction. Comfortable room temperature was maintained at 71 degrees F. Hot water temperature was tested at 115.8 degrees F in one of the bathrooms. Refrigerator temperature measured at 36.3F and Freezer measured at -3F. One week supply of nonperishable and 2-day supply of perishable foods were available and in compliance with regulations. Employee's files and residents files and a sample of medications were reviewed. Employees were fingerprint cleared. Centrally stored medications were locked in medication room. LPA observed a sample of medication. The facility had a written emergency disaster plan dated 11/27/2023. Disaster drill was last conducted on 09/21/2023. Smoke detector and sprinklers were observed throughout facility. Fire extinguisher was last serviced 9/12/2023. ED holds current administrator certificate that expires 7/22/2024 The following deficiencies were observed: At approximately 9:55AM during resident file review R4's file was missing Safeguards for Property/Valuables, Consent Form, and Personal Rights. At approximately 11:50AM during employee file review all employee files were observed incomplete. At approximately 11:55AM during employee file review it was observed that required staff are missing first aid training. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 12/04/2023: 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 Updated facility sketch The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.