Routine inspection·September 19, 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 Licensee Ron Sandone. During this visit, LPA toured the facility inside & out. Resident bedrooms contained required furnishings and lighting. LPA observed required items in bathrooms which were clean. Resident hygiene supplies were properly stored and available. 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 locked and stored separate from food. Medications are centrally stored and locked. First aid kit contained required items. Facility has designated visitation areas available inside and out. Outside of the facility toured. LPA observed a self-releasing gate and windows have screens in good repair. Smoke and Carbon Monoxide detectors present and in working order. Fire extinguisher was purchased 5/17/23. LPA conducted resident and staff file reviews including medication audit. Infection Control and Emergency Disaster Plans were reviewed. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D in the area of: Hospice Care for Terminally Ill Residents Appeal for deficiency CCR 87633(b)(6)(B) was granted. An exit interview was conducted and Plan of Correction (POC) was developed. A copy of this report and Appeal Rights were discussed with and emailed to Ron Sandone. LPA requested the following updated forms faxed to CCLD by 9/26/23: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Personnel Report (LIC 500), Client Roster (LIC 9020), Proof of current Liability Coverage, Infection Control Plan and Emergency Disaster Plan LIC610E.