Routine inspection (multi-day)·October 12, 2023

Licensing Program Analysts (LPA) Katie Brown and Lissett Padgett arrived unannounced to conduct the required Annual inspection. LPA met with Administrator Jennifer Vasquez Administrator (AD) and explained the purpose of the visit. Facility was toured with Memory Care Director Traci Horn (MCD). During this visit, LPAs toured the facility inside & out. Resident rooms contained required furnishings and lighting. LPAs observed required items in bathrooms with hot water measuring between 110.1 to114.4 degrees F. Resident hygiene supplies were properly stored and available. The kitchen was toured observed in good repair with necessary items and appliances and sharps/knives were properly stored. LPAs observed required food supply and paper products. Medications are centrally stored and locked. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility including outdoors, delayed egress gate was found to be in working order. First aid kits are located throughout the building and found to contain required items. Fire Extinguishers are located throughout the facility and were serviced in 2023. Smoke and Carbon Monoxide detectors are tested annually with Jorgensen fire safety company. LPAs conducted resident and staff file reviews and interviews. Administrator’s re-certification was confirmed to be in pending status and was received by the Department as required. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D. See LIC 809C for continuation of this report. 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 Resident Care Director, Melinda Ocaranza, whose signature on this form confirms receipt of these documents. LPA requested the following updated forms faxed to CCLD by 10/19/2023: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Emergency Disaster Plan LIC610E, Infection Control Plan review page, Personnel Report (LIC 500), Client Roster (LIC 9020) and Proof of current Liability Coverage