Routine inspection·October 11, 2022

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced annual inspection visit. LPA was greeted by Silvia Deleon DSP and with met Assistant Administrator Vanessa Ricchiazzi who arrived a short time later and LPA explained the purpose of the rvisit. The facility has a capacity of six (6). Its fire clearance is approved for five (5) non-ambulatory, one (1) bedidden and six (6) hospice waivers. Current resident census is six (6). No resident is on hospice. During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed. The facility is in a residential area. A physical tour was conducted. The facility is a single-story home with six (6) client’s bedrooms, three (3) bathrooms, a living room, a kitchen, a dining room, an activity area, a laundry room, and a garage. The kitchen is clean and has the required two (2) days perishable and seven (7) days Non- perishable. All burners and stove tops were in working condition. Residents' bedrooms have dresser, chair, and closet space available. Adequate linen and personal hygiene supply are observed. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 99.9 in one tub and kitchen dispenser was 159.1 degrees Fahrenheit which was not within Title 22 Regulation guidelines. Dual combos which smoke detector is combined with carbon monoxide detector are operable and hard wired. Fire extinguishers are fully charged. Auditory device is operable. The first aid kit is fully stocked. The last Fire/ Emergency Drill was conducted on 8/21/22. All mandated documents and signs are posted in common areas. The outdoor activity area has a shaded patio with ample seating. Medication is centrally stored in a locked storage room and inaccessible to residents. rResident records are stored in a locked storage room and inaccessible to residents. There are no pools and bodies of water on the premises. There are no firearms on the premises. Administrator certificate is current, and the expiration date is 7/29/2023. Deficiencies cited per California Code of Regulations, Title 22. (please see 809D for details) An exit interview was conducted. This report was discussed and provided via email to facility Assistant Administrator, Vanessa Ricchiazzi. (Due to printer not functioning, report is to be emailed to: vpr.projectmanager@gmail.com