Routine inspection·March 28, 2024

On 03/28/2024 at 12:55PM, Licensing Program Analysts (LPAs) T. Syess-Gibson and C. Fowler, arrived unannounced to continue the 1-Year Annual Required inspection visit. LPAs met with Administrator, Kimberly Whittle and explained the purpose of the visit. Administrator certificate #6067792740 expires 10/11/2025. Administrator Paul Henry Salazar certificate # 6056663740 Expires 07/15/2024 arrived at 2:26PM. The facility’s fire clearance was approved for Six (6) Non-ambulatory residents. Facility has hospice waiver for Three (3) residents. LPAs toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. All outdoor and indoor passageways are kept free of obstruction. LPAs did not observe any bodies of water. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPAs 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 108.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non slip shower mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 02/22/2023. First aid kit was observed to be complete. Fire and Disaster drills conducted quarterly. Continued on LIC809C. . continue from LIC 809 LPAs reviewed Medication and conducted Interviews with three (3) residents. LPAs observed the following deficiency: At 2:20pm, LPAs observed all resident records are missing appraisal needs and service plans (ANS), Updated Physician Reports (MA), Consent Forms (CF), Emergency Identification (ID) and Personal Rights. LPAs requested the following documents to be submitted to CCLD by 04/04/2024. Residents roster · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan (9 pages) · Liability Insurance Deficiency is cited per Title 22 California Code of Regulations and listed on Lic 809D. Exit interview conducted; A copy of this report and appeal rights provided to Administrator