Routine inspection·May 1, 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 (AD) Heidi Setty. During this visit, LPA toured the facility inside & out. Resident bedrooms contained required furnishings and lighting. LPA observed hand washing signs and required items in bathrooms. Resident hygiene supplies were properly stored. Hot water temperature measured within required range. The kitchen observed 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 delayed egress doors and gates in Memory Care. Doors and passageways are unobstructed throughout the facility and outside. Fire Extinguishers dated 12/28/22. Smoke and Carbon Monoxide detectors present and in working order. LPA conducted resident and staff file reviews and interviews. Administrator Certification expiration 7/29/24. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-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 Heidi Setty, whose signature on this form confirms receipt of these documents. LPA requested the following updated forms faxed to CCLD by 5/22/23: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Emergency Disaster Plan (Lic610E), Personnel Report (LIC 500), Client Roster (LIC 9020), Proof of current Liability Coverage.