Routine inspection·August 20, 2024

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. LPA met with and explained the reason for the visit with Robena James. Administrator Cheryl Whittle was contacted and authorized Facility Designee Laplac "Chris" Maxie to continue the visit and sign reports. During this visit, LPA toured the facility inside & out. Resident bedrooms contained required furnishings and lighting. LPA observed required items in bathrooms with hot water measuring at 114 degrees. Resident hygiene supplies were observed as well as a backup supply. The kitchen was observed to be clean, in good repair with necessary items and appliances. LPA observed required food supply and paper products. Knives, cleaning/disinfecting supplies and chemicals are stored separate from food. Medications are centrally stored and locked. A First aid kit contained required items. Facility has designated visitation areas available inside and out. Outside of the facility toured. LPA observed windows with screens in good repair. Doors and passageways are unobstructed throughout the facility and outside. Fire Extinguisher was serviced 2/27/24 by Jorgensen Co. LPA reviewed fire drill logs. Smoke and Carbon Monoxide detectors present and tested during the visit. LPA conducted resident and staff file reviews as well as medication audit. Required postings were observed throughout the facility. Emergency Disaster and Infection Control Plans were reviewed during the inspection. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D in the areas of: Storage Space, Incidental Medical and Dental Care Services, Medical Assessment . An exit interview was conducted and Plan of Correction (POC) developed. A copy of this report was signed by and Appeal Rights were provided. LPA requested the following updated forms faxed to CCLD by 9/3/24: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (Lic402), Emergency Disaster Plan LIC610E, Personnel Report (LIC 500), Client Roster (LIC 9020), Proof of current Liability Coverage.