Routine inspection·September 19, 2023

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility using the Care Tool. LPA Mora met with Rona Lomeda (Administrator) and explained the reason for the visit. The facility is licensed to serve 6 non-ambulatory residents ages 60 and over, of which 6 may be bedridden. Facility has a hospice waiver for 6 residents. The facility is operating within the scope of its license. A tour of the single-story facility included: 5 resident bedrooms, 1 resident bathroom, 1 staff/visitor restroom, living room, kitchen, dining area, nurse station, laundry room, front yard, backyard, and de-attached garage. LPA and Rona toured the facility, and the following was observed: sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. 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 the resident bathroom and measured at 105.2 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. The shower has non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in the laundry room. The living room has a fireplace with a glass cover, making it inaccessible to residents in care. Smoke detectors were observed in each room and throughout the facility and are properly operating. Two carbon monoxide combined with smoke detectors were observed in the hallway and dining area and are properly operating. Fire extinguisher was observed in the living room which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps and cleaning supplies are kept locked under the kitchen sink. First Aid kit was fully stocked with current manual and it is kept in the medication cabinet. 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 laundry cabinet. Residents and staff files are centrally stored in the nurse station. LPA reviewed medication for 6 residents and observed that medications are documented properly and given as prescribed. LPA reviewed files for all 6 residents and 4 staff. No deficiencies were observed with the files. LPA observed administrator certificate for Rona Lomeda – 6051556740 with an expiration date of 10/06/2023. LPA interviewed 2 staff and 2 residents. Per California Code of Regulations, Title 22, and California Health and Safety Code, there was no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.