Routine inspection·April 17, 2024

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:50 a.m., the LPA met with staff and explained the reason for it visit. At 10:16 a.m., the Administrator arrived at the facility. At 10:21 a.m., the LPA, along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. At 10:10 a.m., the LPA conducted an interview with one (1) out of six (6) residents. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked safety box found on top of the kitchen counter. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:39 a.m., hot water measured at 110.0-degree Fahrenheit. BEDROOMS: The facility is a single-story residential home with five (5) bedrooms, four (4) for resident use and one (1) for staff use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: The facility has three (3) bathrooms for resident's use. Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 10:30 a.m., hot water measured between 106.3 and 112.6-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. OUTDOOR SPACE: At 10:33 a.m., the LPA observed the back and side patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. The garage is attached and remains inaccessible to residents. Passageways were free and clear from obstruction. There are no bodies of water on the premises. Continued on LIC-809-C. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguishers to be fully charged and last purchased on 10/15/2023. At 2:06 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Night lights were present in the hallways and passages. All exits have functioning auditory devices and were operational at the time of the visit. First aid kit is located near the front entrance. Medications are stored in locked cabinet located between the kitchen and common areas. The LPA observed cameras in the common areas. RECORD REVIEWS: Between 10:47 a.m. and 12:30 p.m., the LPA conducted a file review for all residents and staff regularly scheduled. Staff records were reviewed for documents including, but not limited to health screening, TB test, staff training records, and fingerprint clearance. Staff have current first aid and training appeared to be completed. Resident records were reviewed for, but not limited to care plans, medical assessments, admissions agreement, consent forms. The following was noted: One (1) out of two (2) residents with dementia diagnosis did not have updated physician’s report/ medical assessments. Technical violation issued and discussed with Administrator. Three (3) out of six (6) residents require updated appraisals/needs and service plan. Three (3) out of six (6) residents need assistance/ depend on others to perform all activities of daily living (ADLs). The LPA had a discussion with the Administrator regarding Prohibited Health Conditions. Facility fire drill was last conducted on 01/08/2024 and disaster drill was last conducted on 01/10/2024. Administrator certificate is current and valid until 02/03/2026. Due to time constraints the LPA will return to complete the annual at a later date. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8 and California Health and Safety Code the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted. The Administrator authorized staff, Svetlana Petrosian to sign the report. A copy of the report and appeal rights were provided.