Routine inspection·June 6, 2023

Licensing Program Analysts (LPAs) Katie Brown and Miriam Flores arrived unannounced to conduct the Annual Inspection. LPAs met with and explained the purpose of the visit with Administrator (AD) Donna Hurley. During this visit, LPAs toured the facility inside & out. Resident bedrooms contained required furnishings and lighting. LPAs observed hand washing signs and required items in bathrooms. Resident hygiene supplies were properly stored and available. The kitchen observed 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. Medications are centrally stored and locked. First aid kit contained required items. Hot water measured within required range. Facility has designated visitation areas available inside and out. Outside of the facility toured. LPAs observed a self-releasing gate and windows have screens in good repair. Doors and passageways are unobstructed throughout the facility and outside. Fire Extinguishers dated 4/1/23. Smoke and Carbon Monoxide detectors present and in working order. LPA conducted resident and staff file reviews and interviews. A deficiency is 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 emailed to Donna Hurley whose signature on this form confirms receipt of these documents.