Routine inspection·March 5, 2024

Licensing Program Analyst's (LPA's) Val Maldonado and Tyler Reyes made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA's Maldonado and Reyes met with Administrator, Tiffany Vander Poorten, and explained the purpose for the visit. During today's visit, LPA Maldonado conducted a tour of the physical plant with Administrator, observed the facility food supplies, reviewed (6) resident medications, (6) resident files, (3) staff files, and conducted interviews with (3) staff, and attempted interviews with (6) residents. The facility is a single-story home, operating as a Residential Care Facility for the Elderly. It is licensed to serve (6) older adults, ages 60 and over. There is a fire clearance approved for (6) non-ambulatory residents. It has an approved Dementia Care Plan and a Hospice Waiver approved for (6) residents. There are currently (2) resident receiving hospice services. An approved mitigation plan is in place and Infection Control plan has been submitted to the department for review. The facility has an active and current liability insurance policy on file. At about 9:10AM, upon entry to the facility, LPA's Maldonado and Reyes observed surveillance cameras in the dining room, living room, and TV room. This facility does not have approval to have surveillance cameras in use. LPA observed all resident bedrooms to have the required furniture, sufficient lighting, and closet/storage space. There are (2) full bathrooms in the home. (1) bathroom is designated for resident use and one for staff/visitor use. Resident bathroom is equipped with required grab bars and non-skid mats for the shower. The hot water was tested and measured at 112.8*F, which is in compliance . Food supplies was observed and was sufficient as required. Emergency food supplies and water were available. First aid kit and manual were observed. There were no bodies of water observed on the premises. Fire extinguishers were observed throughout, with current inspections and were fully charged. All sharps and cleaning supplies/toxins were observed to be locked and inaccessible to residents in care. The last fire drill was conducted in January 2024. Auditory devices were observed at all entrances/exits of the home and were operational. Smoke/carbon monoxide detectors were tested and observed to be operational during the visit. (6) resident files and (3) staff files were reviewed and observed to be complete with all required documentation. (6) resident medications were reviewed and were observed to be documented properly and given as prescribed. Per California Code of Regulations, Title 22, deficiencies were observed and cited on the LIC809-D. An exit interview was conducted and a copy of this report was provided.