Routine inspection·July 26, 2023

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 Rob Huntley (AD) and Director of Nursing Leo Lopez (DON). During this visit, LPA toured the facility inside & out. Resident apartments contained required furnishings and lighting. LPA observed required items in bathrooms with hot water measuring 107 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. LPAs observed required food supply and paper products. Knives, cleaning/disinfecting supplies and chemicals are locked and stored separate from food and menus posted. Medications are centrally stored and locked, a medication audit was conducted. First aid kits contain required items. Facility has designated visitation areas. An activity calendar was posted. Outside of the facility toured. LPA observed a delayed egress gate from the Memory Care garden. Doors and passageways are unobstructed throughout the facility including outdoors. Fire Extinguishers dated 3/27/2023. Smoke and Carbon Monoxide detectors present and in working order. LPA conducted resident and staff file reviews and interviews. Administrator certification expiration 5/31/24. LPA reviewed Emergency Disaster Plan and Liability coverage during the inspection. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D. An exit interview was conducted and 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 8/9/23: 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)