Routine inspection·July 18, 2023

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility using the CARE Tool. LPA Mora met with Marie Resurreccion (Assistant Administrator) and explained the reason for the visit. The facility is licensed to serve 4 non-ambulatory residents age 60 and over. Facility is approved for 1 hospice waiver. The facility is operating within the scope of its license. A tour of the single-story facility included the living room, dining room, kitchen, staff room, 4 client bedrooms, 2 client bathrooms, front yard, backyard, and attached garage. During the tour the following was observed: the front porch and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. Auditory devices were seen on exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in both bathrooms and measured at 105 degrees F and 105.2 degrees F which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in a hallway closet. Smoke detectors combined with carbon monoxide were observed in each room and throughout the facility, and were properly operating. There is one fire extinguisher located in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are kept locked in a kitchen cabinet and are inaccessible to residents. Cleaning supplies and toxins are kept locked under the kitchen sink and are inaccessible to residents. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. First Aid kit was fully stocked with current manual and it is kept locked in the medication cabinet. Residents and staff files are centrally stored in the living room closet. Residents medication are centrally stored in a locked kitchen cabinet. LPA reviewed medication for all 4 residents and observed that medications are documented properly and given as prescribed. LPA reviewed files for all 4 residents and 6 staff. LPA reviewed P&I funds for 3 residents with staff present. The other resident manages their own P&I funds. LPA interviewed 2 residents and 2 staff. Facility has a valid surety bond and liability insurance. (Continued to LIC 809-D) Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.