Routine inspection·January 11, 2024

Licensing Program Analyst (LPA) A Gomez arrived unannounced to conduct a 1-Year Annual Required inspection on this date starting at 12:00pm. LPA met with Executive Director, Kirsten Korfhage and explained the reason of the visit. The facility's fire clearance was approved for all may be non-ambulatory which 10 may be bedridden. At 3:10pm, LPA toured facility with Executive Director, including but not limited to apartments, bathrooms, kitchen, dining area, multiple activity rooms and courtyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the random residents’ bathroom were maintained at 115.2 and 110.3 degrees F. Residents’ bathrooms are equipped with grab bars and non-skid mats/non-skid shower pans. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication carts were inaccessible. Refrigerator temperature was maintained at 36 degrees F and freezer temperature is maintained at -13 degrees F. Smoke detectors, carbon monoxide and sprinklers were observed throughout the facility. Fire extinguisher was last serviced on 10/14/2023 . Emergency Disaster Plan was last posted on 10/20/2023. First aid kit was observed to be complete. Fire drill was last conducted on 12/27/2023. At 12:40pm, LPA reviewed 5 residents records. At 3:25pm, LPA reviewed 5 staff records and 5 of 5 staff are fingerprint cleared. REPORT CONTINUES ON 809C The Following Deficiencies were observed: At 1:42PM during facility tour LPA observed unlocked full sharps disposal container in R5's room in closet on the floor. ED had med-tech dispose of bin. Deficiency Cleared. Between 1:45PM and 2:03PM during facility tour LPA observed Virex cleaner, scissors, and prescription powder in R1's apartment . LPA also observed scissors and whiskey in R3's apartment. ED removed all items from residents apartments clearing the deficiency. At 3:30PM during staff file review LPA observed that S4 does not have a health screen or TB test on file. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 2/01/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (9 pages) Liability Insurance Current Administrator’s Certificate The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency by POC date may result in Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.