Routine inspection·February 1, 2024

On 02/01/2024 at 12:00 PM, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced annual inspection visit at the Pepper Tree Assisted Living 2 Facility. LPA Calderon was allowed entry into the facility by Staff Mario Pangan. Staff Mario Pangan was asked questions regarding the full care tools control package (13) sections. Staff Mario Pangan took LPA Calderon temperature prior to entrance into the facility. Facility is licensed for (6) non-ambulatory residents. LPA Calderon explained to Staff Mario Pangan, the purpose of the one-year (1) Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: six (6) resident service records, six (6) resident medication records, two (2) staff records. LPA Calderon interviewed six (6) residents and two (2) staff members for visit. LPA Calderon inspected the inside facility and outside grounds to include all common areas. The facilities’ last fire drill was conducted on 11/03/2023 . The two-story residential home consists of five (5) resident bedrooms, three (3) resident bathrooms, living room, dining room, family room, kitchen, office area, attached garage with washer and dryer/ storage area, backyard with table and chairs. No weapons are stored in the premises. Kitchen was inspected and observed to be clean and operational. A two-day (2) supply perishable and seven-day (7) supply of non-perishable foods are present in the facility. Emergency Water seven-day (7) supply is found in the garage. LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of resident’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked closet with bedding, towels, and toiletries supplies . Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 109 degrees Fahrenheit. Bathroom #2 hot water temperature properly measured at 110 degrees Fahrenheit. Bathroom #3 hot water temperature properly measured at 112 degrees Fahrenheit. Kitchen hot water temperature properly measured at 116 degrees Fahrenheit. Facility (2) carbon Monoxide and (10) Smoke Detectors hard wired and were tested and are working properly. The facility two (2) Fire Extinguishers were checked and found to be fully charged and accessible . All exit doors in the facility have alarm systems. All toxins and knifes are locked/secured and inaccessible to residents. Medications are centrally stored and in a locked storage cabinet. Facility first aid kit (1) is fully stocked with manual was checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to residents. LPA Calderon noted the Administrator Marhlyn Sapugay Certification # 6018525740 expiration date of 10/03/2024 was valid at time of visit. The facility does NOT handle resident's money/cash resources and a NO Surety bond is needed. Commercial General Liability Policy #01002294880 policy period from 03/03/2023 to 03/03/2024 underwritten by Kinsale Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. LPA Calderon spoke to Administrator Marhlyn J Sapugay who will email full copy of insurance contact which shows all coverages to LPA Calderon no later than 02/28/2023 . All the required documents are posted in the facility in a clearly visible area to all staff, clients, and guests. LPA Calderon reviewed LIC500 and noted all staff associated to facility per LIS. LPA Calderon reviewed the resident roster, LPA Calderon confirmed residents’ interview are on resident roster. During the visit, LPA Calderon observed the facility infection control practices. LPA Calderon observed screening protocols for visitors, staff, and residents, sanitizing stations (Located in common areas and restrooms). LPA Calderon observed staff and residents were NOT wearing face coverings. LPA Calderon observed the facility has a thirty-day (30) supply of Personal Protective Equipment (PPE). LPA Calderon advised the Staff Mario Pangan to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe any deficiencies therefore NO citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Staff Mario Pangan.