Routine inspection·April 27, 2023

Licensing Program Analyst (LPA) Darius Williams conducted an unannounced Annual Inspection visit. LPA Williams met with Administrator Gerald Declaro and discussed the purpose of the visit. All residents were in programs. LPA Williams toured the facility with the Administrator. The living room was clean, good repair, and had seating available for all residents. The bathroom is near the front entrance. It was clean, in good repair, and had non slip mats and grab bars available for use. Three of the four bedrooms are occupied. All bedrooms had bed, required linens, chair, dresser, night stand, and lamp. LPA Williams observed extra linens and hygiene in the hallway closet. The dining room accommodated all residents. Two days of perishable food and seven days of non perishable food was observed. Refrigerator temperature reflected approximately 30 degrees Fahrenheit (F) and water temperature reflected approximately 107 degrees F. The backyard had a covered area for residents and was free of obstruction. There is no pool on the premises. *Continued on LIC 809-C* Smoke detector, carbon monoxide, and fire extinguisher were present and operational. First aid kit was present with all required items. Chemicals and medications were locked and inaccessible to residents. LPA Williams reviewed three resident files. Between the three residents the most recent input date for Centrally Stored Medication logs was August 2022. Additioanlly, Resident 3 admission agreement had a date of 5/12/2021. However, there was no signature from the resident, authorized representative or facility representative. Based on today's inspection, a deficiency were cited in the areas evaluated and listed on the LIC 809D page, according to California Code of Regulations Title 22, Division 6. Plan of Correction was developed and reviewed with the Administrator. An exit interview was conducted and a copy of this report and appeal rights will be provided via e-mail.