Routine inspection·March 21, 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 Ronald Sandone and Interim Administrator (AD) Yolonda Casttigador. During this visit, LPA toured the facility. Furniture and flooring in common rooms observed to be in good repair with adequate lighting throughout. Resident bedrooms have required furnishings, lighting and linens. LPA observed hand washing signs and required items in bathrooms. Resident hygiene supplies were properly stored. The kitchen observed clean, in good repair with necessary items and appliances. LPA observed required food supply, paper products and PPE. Knives, cleaning/disinfecting supplies and chemicals are locked and stored separate from food. Facility has designated visitation areas available inside and out. LPA observed a self-releasing gate and windows have screens in good repair. Doors and passageways are unobstructed throughout the home and outside. Smoke and Carbon Monoxide detectors present and in working order. Emergency & Disaster Plan and Infection Control Procedures reviewed; Administrator Certification expires 8/12/24. LPA conducted resident and staff file reviews and interviews. Deficiencies are 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 Ronald Sandone, whose signature on this form confirms receipt of these documents. LPA requested the following updated forms by 4/4/2023: Designation of Facility Responsibility (LIC 308), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (LIC 402 if applicable), Personnel Report (LIC 500), Emergency Disaster Plan (610E), Client Roster (LIC 9020), Current Liability Coverage,