Routine inspection·September 21, 2022

Licensing Program Analysts (LPAs) Tao and Ramirez conducted an unannounced annual inspection visit. LPAs met with staff, Cherry Serame and Primitivo Serame, who assisted with the visit. LPAs notified administrator upon arrival and spoke with Administrator, Trupti Mody at the end of the visit over the phone. Facility is licensed to serve six (6) non-ambulatory, developmentally disabled residents who are age 60 and above. Annual licensing fees are current. During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed. The facility is located in a residential neighborhood. LPAs toured the facilities physical plant, indoor and outdoor. The facility has five (5) resident bedrooms, two (2) staff bedrooms, three (3) full bathrooms, living room, kitchen, dining room, TV room and an indoor/covered outdoor activity area. All the rooms were furnished with appropriate furniture for residents’ comfort. The bathrooms were furnished with grab bars and nonskid surfaces. Common areas were observed for the ability to safely serve the needs of the residents. Hot water temperature was measured at 114.6 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. No pools and bodies of water on the premises. Facility maintained a comfortable temperature for residents. Auditory alarm devices to monitor exits were operable. Interior and exterior space available to permit residents to wander freely and safely. Sufficient supply of perishable and nonperishable foods is observed. Knives, tools, sharp items are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable. Fire extinguishers’ last service is 01/26/22 and are fully charged. (-continued in LIC 809C-) Mandated documents and signages are posted in common areas. The outdoor activity area has a shaded patio with ample seating. Medication are centrally stored in a locked cabinet in the kitchen and inaccessible to residents. Resident records are stored in a locked cabinet and inaccessible to residents. Toxic substances are inaccessible to residents. Outdoor facility space are available for residents and leisure. Deficiencies were observed and cited per California Code of Regulations, Title 22 in LIC 809 D. An exit interview was conducted. This report was discussed with Staff, Cherry Serame. Staff’s signature on this form confirm receipt of these documents. A copy of LIC 809s report and appeal rights were provided.