Routine inspection·August 2, 2023

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced annual visit and was greeted by Caregiver. The Administrator was at an appointment; however, LPA Spaeth spoke to the Administrator via phone at 9:30 am. The facility is licensed as a Resident Care Facility for the Elderly to serve five residents of which five may be non-ambulatory and one bedridden. There are three residents living in the facility. LPA reviewed residents' records at 9:40 am until 10:15 am. LPA and Caregiver began the tour of the facility at 10:20 am until 11:00 am. LPA observed the following: Kitchen – LPA Spaeth observed a seven-day supply of non-perishable food and a two-day supply of perishable foods. LPA observed the knives were locked in a kitchen drawer and medications were locked in the kitchen cabinet. The fire extinguisher is located in the kitchen area. Common areas – LPA Spaeth observed the living room and dining room combination contained comfortable seating and a dining room table with chairs. LPA observed the family room also contained comfortable seating and a television. Bathrooms – LPA Spaeth observed both bathrooms contained hand soap, paper towels, slip resistant mat, and a trash can. Water temperature was tested at 10:45 am at 122.0 F. Bedrooms – LPA Spaeth observed there are three bedrooms in the facility and two of the bedrooms are occupied by residents. The bedrooms contained bed, linens, night stand, and night lamp. Laundry Room – LPA Spaeth observed the laundry room was locked. The washer/dryer, cleaning supplies, and laundry soap are safely locked in the laundry room. Backyard – LPA Spaeth observed comfortable seating in a shaded area. The side gate leading from the backyard to the front yard was not locked. Smoke/Carbon Monoxide Detectors – The smoke detectors were tested at 10:50 am. The carbon monoxide detector is operational and located in the family room. Delayed Egress System - LPA Spaeth observed the delayed egress system was properly working on all five exit doors. Pursuant to Title 22 Division 6 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted, Appeal Rights discussed, and a copy of the signed report was given to caregiver.