Routine inspection·July 5, 2024

Licensing Program Analysts (LPA) Tyler Reyes conducted an unannounced annual visit at the facility using the CARE Tool. LPA Reyes met with Elvira David (Administrator) and explained the reason for the visit. The facility is licensed to serve 6 residents over the age of 60, four non-ambulatory and approved for two hospice waivers. The facility is operating within the scope of its license. A tour of the single-story facility included: kitchen, dining area, living room, 3 resident bedrooms, 3 bathrooms, laundry room, backyard, and attached garage. LPA and Administrator Elvira David toured the facility and the following was observed: sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen and garage. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in bathroom and measured at 116.1 degrees F which is within the required 105 - 120 degrees F. The bathroom is 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. Smoke detectors were observed in each room and throughout the facility and are properly operating. Carbon monoxides were observed in the kitchen and family room and are properly operating. Fire extinguishers were observed in the kitchen and family room which are fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are kept locked in a kitchen cabinet. Cleaning supplies and toxins are kept locked in a laundry room cabinet. First Aid kit was fully stocked with current manual and it is kept in the medication closet. The front and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. There are no bodies of water at the facility. Passageways and exits are free of obstruction. (Continued to LIC 809-C) Residents medication are centrally stored in a locked closet in the dining area. Residents and staff files are centrally stored in a dining area cabinet. LPA reviewed medication for all 6 of the residents and observed that medications are documented properly and given as prescribed. LPA reviewed files for all 6 residents and 3 staff. No issues were found with the files. LPA interviewed 2 staff and no residents due to outbreak. Per California Code of Regulations, Title 22, deficiencies were observed and will be cited on the LIC809-D page. Exit interview was conducted and a copy of this report and appeal rights were provided.