Routine inspection·November 7, 2022

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Required Annual visit. LPA met with Administrator David Markie. LPA discussed the purpose of the visit. LPA used the infection control tool to evaluate the facility. LPA observed COVID-19 procedures, reviewed residents’ medications, and records, observed food supply, and reviewed staff records. The facility is a single-story residence located on a cul-de-sac street. The facility has an unfenced front yard, attached 3 car garage, enclosed backyard with an attached patio cover. During the tour, LPA observed a living room area, dining room area, kitchen, 5 bedrooms, and 2 full bathrooms. The facility provides care for elderly residents with dementia and is approved to retain 4 residents on hospice. Currently the facility has 0 residents on hospice. The facility currently has 4 non-ambulatory and 1 ambulatory residents. All resident bedrooms were toured. Each bedroom contained a bed, linen, dresser, chair, light, and sufficient closet space. Resident bathrooms have the required grab bars and non-skid mat. The hot water was between 108.1 degrees which is within the required 105- 120 degrees. Cleaning supplies are inaccessible to residents. LPA observed the refrigerator to not have the sufficient required 2-day perishable and 7-day nonperishables. Continued on 809C LPA reviewed 5 resident records to confirm emergency contact is updated and residents have health screenings on file. 4 staff records were reviewed to confirm health screenings, infection control training, and fingerprint clearances. LPA reviewed 5 residents’ medications. Medications are documented properly and stored in a secure area. Per California Code of Regulations, Title 22, one deficiency was observed during the visit and documented on LIC 809D. Appeal rights explained and exit interview conducted with David Markie.