Routine inspection·January 30, 2024

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) Mark Rivas and Designee, Samantha Capistrano. There are no residents currently admitted to the facility. During this visit, LPA toured the facility inside & out. Resident bedrooms contained required furnishings and lighting. The resident bathroom was clean, LPA observed required hygiene and safety items. Towels, extra blankets, and linens were available for use. Resident bathroom hot water temperature measured 109 degrees. The kitchen was 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 will be centrally stored in a locking cabinet in the kitchen. A First aid kit contained required items. The facility has designated visitation areas available inside and out. LPA observed a self-releasing gate and windows have screens in good repair. Smoke and Carbon Monoxide detectors present and in working order. A Fire extinguisher was purchased on 1/24/2024. LPA conducted a staff file reviews. The Emergency Disaster Plan and Infection Control Plans were reviewed. A resident admission binder was reviewed and contained copies of all required documents. Administrator Certificate Number 6060516740. There were no citations during this inspection. An exit interview was conducted and a copy of this report was provided to Mark Rivas, whose signature confirms receipt. LPA requested the following updated forms faxed to CCLD by 2/6/2024: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Emergency Disaster Plan LIC610E, Personnel Report (LIC 500).