Routine inspection·February 17, 2023

Licensing Program Analyst (LPA) Alberto Lopez arrived at this facility unannounced to conduct an annual inspection visit. Upon arrival, LPA met with Sister Magdalene Grace who assisted with the visit. The purpose of visit was explained. The facility has an approved fire clearance for twenty (20) Non-ambulatory and eight (8) Bedridden residents. The Licensee has a Hospice Waiver for 12 residents. Facility does not have Dementia Care in their plan of operation and not accepting residents diagnosed with dementia. This is a two-story building located in a residential neighborhood. There are 22 resident bedrooms of which 6 are double occupancy. There is only one entrance being utilized at the facility, all required posters were posted at the entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask upon entrance and during visit. LPA toured the physical plant areas inside and outside to ensure compliance with Title 22 regulations. LPA also conducted the infection control domain tool. The first floor consists of a dining room, living room, kitchen, activity room, medication room, laundry room, storage rooms, electrical room, boiler room and 10 resident rooms. The second floor consist of an activity room, living room, office, medication room, laundry room, storage rooms, electrical room, staff break room and 11 resident rooms. LPA toured a randomly selected resident's rooms on each floor. Resident rooms were sanitary and had been furnished appropriately. Each resident room has their own bathroom. The bathrooms were observed to be clean and operational w/grab bars. Resident rooms are equipped with signal systems. There is a signal system located by the resident bed and inside the bathroom. The hot water temperature was tested throughout the facility and measured within Title 22 Regulation guidelines. The facility has central air and heating accommodations. There is a functioning telephone on the premises and there is emergency lighting, such as flashlights and night lights. The fire extinguishers and carbon monoxide detectors were observed. The front grounds of the facility are well landscaped and have a leveled walkway to the entrance. (CONTINUED ON 809C) The kitchen was observed for the ability to prepare and serve food. Appliances in the kitchen were clean and all appeared functional. During today's visit, LPA observed an appropriate food supply of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. All sharp objects and knives are stored in the kitchen cabinet making it inaccessible to residents. All chemicals and cleaning solutions are observed to be locked and inaccessible to the residents. The facility has a fireplace located on both floors of the building (located in the living rooms) but the fireplace does not produce heat and is only for display. Medications and First Aid Kit are centrally stored in the locked medications rooms located on each floor. First aid kit is fully stocked with a manual. Per California Code of Regulations, Title 22, deficiencies were not observed during the visit. Exit interview conducted and a copy of the report and appeal rights were provided.