Routine inspection·June 1, 2023

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE tool. LPA met with Rosalie Sandoval administrator and explained the reason for the visit. The facility is licensed to serve 40 non-ambulatory residents ages 60 and over with an approved hospice waiver for 5 residents. The facility is a 2 story building located in a residential area, it has 20 shared rooms, an activity room, a dining room with kitchenette, a medication room, a cover balcony in the second floor, and a back outdoor area. Facility does not have a kitchen and per the plan of operation they receive food prepared in their sister facility for all resident meals. LPA Flores conducted a tour of the facility with Rosalie Sandoval and observed the following: Dining area is clean. Kitchenette's drawers/cabinets were observed, cleaning supplies were observed in a cabinet without a lock and accessible to the residents. Activity room was observed and the ceiling has water damage of about 3x1 feet. Five resident rooms were observed, room #70,72,82,86,87. Each room has sufficient lighting, and required furniture and bedding supplies. Room #82 was observed to have water damage of about 2x1 feet. A bathroom was observed in each bedroom and water temperature was tested between 108.9 - 122.3 degrees F., which is not within the required 105-120 degrees F. Bathroom tubs in rooms #70 and 72 were observed peeling. The second floor balcony's ceiling was also observed with water damage of about 3x3 feet. Outdoor area has shaded sitting areas. Medication room was observed inaccessible to the residents. Medication was reviewed for 5 residents. LPA reviewed 5 resident/staff files and interviewed 3 residents and 3 staff. Last fire inspections was conducted on 4/27/23. Last fire drill was conducted on 4/10/23. Fire Extinguishers were observed and last checked on 6/30/22. Administrators certificate was observed #6012456740 exp date: 1/24/24. A copy of liability insurance was requested. Deficiencies are noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Rosalie Sandoval administrator and a copy of this report, LIC 809D, and appeal rights were provided.