Routine inspection·April 21, 2022

At 11:30 a.m. on 04/21/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and disclosed the reason for the visit. LPA and staff toured the facility inside and out. The facility was last visited on 06/25/2021 for an annual inspection. It is a single story building with 5 bedrooms, 2 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 non-ambulatory residents, of which 1 may be bedridden in bedroom #5. The facility serves residents with dementia. Approved hospice waivers for 6. Entry: LPA observed a maintained front yard. Entrance path was free from hazards. Signs regarding the facility’s visitation policy and masking requirement hung on the front door. Once inside, LPA observed postings for COVID precautions, ombudsman contact, confidential complaints, personal rights, and “Oxygen in use – No smoking”. Screening: LPA was screened for infectious disease symptoms upon entry. The screening station contained surgical masks, gloves, gowns, digital thermometer, and a visitor log. The visitor log contained contact tracing information, symptoms, and temperature. LPA advised creating a column to track visitor vaccination status. Bedrooms: The facility has 5 bedrooms. 4 bedrooms are designated for residents. Of the 4 resident bedrooms, 2 are private and 2 are shared. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. Beds in the shared bedrooms were at least 6 feet apart to accommodate physical distancing. All furnishings were clean and in good condition. Bedroom #3 and Bedroom #4 had ramps leading out. Ramps and handrails were sturdy and in good condition. Bedroom #2 is designated for staff. The staff room was unlocked and free from hazards. Bathrooms: The facility has 2 bathrooms. Bedroom #3 had a private bathroom. A shared bathroom was located between Bedroom #5 and the staff room. All bathrooms contained liquid soap, paper towels, trash can with a tight fitting lid, grab bars in the shower and by the toilet, and a non-skid surface in the shower. A handwashing instruction sign was observed in the private bathroom but not the shared bathroom. At approximately 11:45 a.m. LPA measured the water temperature in Bathroom #1 to be 113.1 degrees Fahrenheit. Kitchen: LPA observed an adequate supply of perishable and non-perishable food. Hazardous objects were locked. At approximately 12:00 p.m. residents gathered in the living room for lunch. Laundry: LPA observed a washer and dryer in good condition near the kitchen. Detergent was inaccessible to residents and locked by magnet locks. Staff kept the keys in their possession. Common Areas: Walls, floors, ceilings, windows, and blinds were clean and in good repair. A storage cabinet by the shared bathroom contained extra linens. At approximately 11:40 a.m. LPA measured the room temperature to be 73 degrees Fahrenheit. Outdoor areas: A resident was observed sitting outside in a shaded patio area. All furniture was clean and in good repair. LPA also observed a basketball hoop, gas grill, and a locked garage. Safety: All emergency exit paths were free from obstructions. Exit gates were unlocked. Emergency Disaster Plan was posted near the kitchen. Evacuation routes were illustrated and labeled. 2 out of 3 auditory devices were observed on and functioning. At approximately 11:45 a.m. LPA observed the auditory device in bedroom #5 to be off. Staff turned the device on immediately. A fire alarm is located near the front door. At 11:52 a.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 05/21/2021. At 11:53 a.m. LPA tested the smoke and carbon monoxide detector to be operational. 3 other smoke detectors were hard-wired and heard functioning. Pursuant to Title 22 of the CA Code of Regulations, 1 deficiency was cited on the attached LIC 809-D. Exit interview conducted. Copy of report provided. Appeal rights provided. Citation issued.