Routine inspection·November 8, 2023

Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to conduct a required annual visit. LPA explained the purpose of the visit and was granted entry by Administrator, Phoeun Marez. The residence was set at 72 degrees F temperature and free of passageway obstructions inside and outside. LPAs observed six bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked in the kitchen area. Cleaning supplies are locked and stored in the garage. Smoke detectors and carbon monoxide were checked and operating. Fire extinguishers was serviced on 3/16/2023. Last drill completed on 09/06/23. There was outdoor seating for the residents. Outdoor area was clean and free of obstruction. Deficiencies are being cited based on LPA observation in accordance with the California Code of Regulations, Title 22, see LIC809D. During record review it was found that S1 was not clear to work in the facility. During the visit a file review was conducted for residents and staff files. An exit interview was conducted, and a copy of this report was provided to AD1 whose signature confirms receipt. LPA requested the following updated forms faxed to CCLD by 11/15/23: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage.