Routine inspection·February 20, 2024

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. LPA met with and explained the purpose of the visit with Administrator (AD) Joanna Gonzalez. During this visit, LPA toured the facility inside & out. Resident bedrooms are found in good repair, contained required furnishings and lighting. The resident bathrooms were clean and in good repair. LPA observed required hygiene items and grab bars. Towels, extra bedding, and linens were stored and available for use. The kitchen was clean, in good repair with necessary items and appliances. LPA observed required food supply, PPE and paper product storage. Knives/sharps, cleaning/disinfecting supplies and chemicals are locked and stored separate from food. Medications are centrally stored in a locked cabinet. A First aid kit contained required items. There are visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility. LPA observed a self-releasing gate and windows have screens in good repair. Smoke and Carbon Monoxide detectors were tested during the visit. The Fire extinguishers were serviced 9/21/23 by Jorgenson Co. LPA conducted resident and staff file reviews including medication audit. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D in the areas of: Plan of Operation and Allowable Health Conditions and the Use of Home Health Agencies. An exit interview was conducted and Plan of Correction (POC) developed. A copy of this report was signed by AD and Appeal Rights were provided. LPA requested the following updated forms faxed to CCLD by 3/5/2024: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Emergency Disaster Plan (LIC610D), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (Lic402) Personnel Report (LIC 500). Client Roster (LIC 9020), Proof of current Liability Coverage.