Routine inspection·October 5, 2023

Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by caregiver staff and explain the purpose of the visit. Administrator Jill Stowell (AD1) arrived at the facility minutes after to complete the inspection tour. The residence was set at 75 degrees F temperature and free of passageway obstructions inside and outside. LPAs observed six bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. Hot water temperature was measured at 108.4 degrees F. Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked next to the kitchen area. Cleaning supplies were locked under kitchen sink. Smoke detectors and carbon monoxide were checked and operating. Fire extinguishers were charged and was serviced on 2/3/2023. Last drill completed on 2/2/23. There was outdoor seating for the residents. Outdoor area was clean and free of obstruction. During the visit a file review was conducted for residents and staff files, refer to 809D for deficiencies. An exit interview was conducted, and a copy of this report was provided to AD1 whose signature confirms receipt. LPA requested the following updated forms faxed to CCLD by 10/12/23: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage, and Plan of Operation, fire drill training.