Routine inspection·May 18, 2021

Licensing Program Analysts (LPAs) Joe Katrdzhyan and Nina Galarza conducted a site visit for the Required - 1 Year inspection. Upon arriving at the facility, LPAs met with Mike Carrasco / Business Office Director and were later joined by the Health Services Administrator / Andrew Smith and Director of Wellness / Sev Tienda, who assisted with the visit. The facility is licensed to serve for a capacity of two hundred (200) Non-ambulatory residents ages 60 and above. The facility has an approved Hospice Waiver on file for six (6) residents. The facility also has an approved Dementia Care plan as part of their operation. This is a Continuing Care Retirement Community (CCRC) which includes two separate levels of care; Independent Living and Assisted Living. The Assisted Living residents are located in the Memorial Lodge (ML) and Shu Lodge (SL). Memory Care residents are located in the Hacienda Building. There are currently 26 residents residing in Assisted Living, 7 residents in Memory and 111 residents in Independent Living. There are zero (0) residents receiving hospice services. The facility does NOT have a bedridden fire clearance. During today's visit, LPAs used the infection control domain to complete the Required - 1 Year inspection. Also, the physical plant was toured, medications and food supplies reviewed. LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. During the tour, LPAs were accompanied by Mr. Smith and Mr. Tienda. LPA toured a random selection of resident rooms. Resident rooms were furnished appropriately. Each resident room has their own bathroom. The bathrooms were observed to be clean and operational w/grab bars. The hot water temperature was tested throughout the facility. The facility has central air and heating accommodations. The front grounds of the facility are well landscaped and have a leveled walkway to the entrance. The outdoor area was enclosed. There are various yard areas throughout the facility that are equipped with patio furniture for resident comfort and safety. (Please see LIC 809C for Additional information) Facility has a working landline. The kitchen was observed. There was a sufficient amount of perishable and non-perishable food supplies. No pesticides or poisons were stored in the food areas. Medications are centrally stored and locked in each of the lodges/buildings stated on this report. All required information (COVID-19, Emergency Exiting Floor Plan, Personal Rights, Ombudsman information, Theft and loss policy and Emergency Telephone Numbers) are posted in the facility. The following deficiencies were observed during today's visit; At 10AM, the hot water temperature in room #10, located in the Shu Lodge was measured at 122.8 degrees F. At 10:50AM, LPAs observed both exit gates located in the Hacienda building were locked with a padlock and an automatic latch preventing residents from exiting the facility (through the back) in case of an emergency. At 10:50AM, LPAs observed the self closing mechanism/latches on both exit gates in the Hacienda Building were in disrepair as both gates would not self-close. At 10:55AM, LPAs observed the delay egress devices on both exit gates located in the Hacienda building were inoperable. The following deficiencies were observed to be in violation of California code of Regulations, Title 22, Division 6 (refer to 809D) An exit interview was conducted and a copy of this report was provided to the Health Services Administrator along with the Appeals Rights.