Routine inspection·November 27, 2023

Licensing Program Analysts (LPA) Regina Cloyd made an unannounced visit, and met with staff, Marcia Bailey, to conduct an annual unannounced inspection using the CARE Tool. The facility is licensed to serve elderly ages 60 years and over. Approved capacity is for four (4) ambulatory residents, zero (0) non-ambulatory residents, and zero (0) bedridden residents. Structure: Facility is a one-story family home with three (3) bedrooms, (2) full bathrooms, living room/ dining area, and kitchen. A car port / shaded area is located on the front of the property; LPA observed two (2) bench to be used for resident seating. Total of two (2) exits; main exit located in living room, exit two is in bedroom #1. Front yard landscape is in good condition at time of visit. A locked closet/storage space located across from bedroom#3 is used for extra linens, towels, and hygiene supplies. Washer/Dryer appliances are located in the kitchen. There are no firearms in the home. Bedroom: Bedrooms are equipped with one bed per resident, night-stand, chair, and overhead lightning. Bathrooms: bathrooms have a working toilet, wash basin, tub/shower. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, fitted sheet, blanket and bedspreads. One fully charged fire extinguisher is located near the kitchen . Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in kitchen drawer inaccessible and under lock. Smoke Detectors/Carbon Monoxide(s): Facility is equipped with three (3) operational dual/ hardwired smoke detectors and carbon monoxide. Appliances: Stove burners (gas), oven, microwave, and washer/dryer are in working condition. There is one working (1) refrigerator in the home and working cordless telephone is located in the living room. Toxins: Cleaning supplies and toxins are stored and locked in kitchen sink cabinet. Water Temperature: Hot water was tested in bathroom #2; temperature was 118.2 Degrees F. Medication, First-Aid Kit & Book: Designated centrally stored medication area was locked and located in a standing cabinet space located in the Living room. Sufficient bandages and one (1) tweezer. Facility has First Aid Kit, Manual thermometer and scissors. Pools/Jacuzzi & Pets: No bodies of water and no pets on these premises. 5 staff records were reviewed, 5 out of 5 staff records had current first aid certificates. Two staff were interviewed. 2 resident records were reviewed and, 2 out of 2 residents records had Admission Agreements. Two residents were interviewed. During record review, LPA did not observe 2 out of 4 health screening reports for staff, which poses a potential health and safety risk to the persons in care. During record review, LPA did not observe documentation of a medical assessment, signed by a physician, made within the last year for R#2. Deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, technical assistance provided, and plans of corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Marcia Bailey .