Routine inspection·October 3, 2023

Licensing Program Analysts (LPAs) Katie Brown and Lissett Padgett arrived unannounced to conduct the Annual inspection. LPA met with and explained the purpose of the visit with Administrator (AD) Cheryl Whittle. During this visit, LPA toured the facility inside & out. Resident rooms contained required furnishings and lighting. LPA observed required items in bathrooms with hot water measuring 117 degrees F. Resident hygiene supplies were properly stored and available. The kitchen was observed to be clean, in good repair with necessary items and appliances. LPA observed required food supply and paper products. Medications are centrally stored and locked. First aid kit contains required items. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the home including outdoors. Fire Extinguishers dated 3/20/23. Smoke and Carbon Monoxide detectors are present and in working order. LPA conducted resident and staff file reviews, interviews and a medication audit. Administrator certification expires 10/17/24. Emergency Disaster Plan and Infection Control Plan were reviewed during this visit. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D in the areas of: Safeguards for Resident Cash, Personal Property, and Valuables, Maintenance and Operation and Storage Space. An exit interview was conducted and a Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with AD, whose signature on this form confirms receipt of these documents. LPA requested the following updated forms faxed to CCLD by 10/12/23: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (Lic402), Personnel Report (LIC 500), Client Roster (LIC 9020) and Proof of current Liability Coverage, Emergency Disaster Plan LIC610E.