Routine inspection·February 2, 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 Asst. Administrator/Facility Designee (AD) Alex Babakhani. During this visit, LPA toured the facility inside & out. Resident bedrooms are found in good repair, contained required furnishings and lighting. The resident bathroom was clean and in good repair. LPA observed required hygiene items and grab bars. Towels, extra bedding, and linens were stored and available for use. Resident bathroom hot water measured 107.4 degrees. The kitchen was clean, in good repair with necessary items and appliances. LPA observed required water, food supply, PPE and paper products. Knives/sharps, are locked and stored separate from food. Medications are centrally stored in a locked cabinet in the kitchen. A First aid kit contained required items. There are visitation areas available inside and out. LPA observed a self-releasing gate and windows have screens in good repair. Smoke and Carbon Monoxide detectors are present and were tested during the visit. The Fire extinguishers were purchased 4/12/2023. LPA conducted resident and staff file reviews. The Emergency Disaster Plan and Infection Control Plans were reviewed, AD has agreed to update both. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D in the areas of: Storage Space and Personal Accommodations and Services. 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. See Lic809C for continuation of this report LPA requested the following updated forms faxed to CCLD by 2/16/2024: 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 and the updated Infection Control Plan.