Routine inspection·April 22, 2022

Licensing Program Analysts (LPAs) Tao and Calderon conducted an unannounced annual inspection visit. LPAs met with Martha Garcia, staff who assisted with the visit. Around 1:30 pm, Licensee, Amber Branconier joined the visit and assisted with the visit. The facility has a capacity of 120 residents. It is licensed to serve elderly residents age 60 and above, approved for 120 non-ambulatory residents of which 21 may be bedridden. The facility has five (5) Hospice Waivers on file. Annual licensing fees are current. LPAs discussed the purpose of today's visit. 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 a two-story building with 60 resident rooms. Facility consisted of Lobby/Reception Area, office, medication room, Activity Room, TV/Entertainment Room, Beauty Shop, Employee Room with lockers and time clock, laundry room, kitchen, and dining room. Residents' medications were centrally stored, locked and the records are current. Hazardous items are locked and inaccessible to residents in care. Hallways were clean and free of obstructions. Common areas were well organized and free of hazards. LPAs inspected Resident room # 103, 106, 120, 216 and 225. Resident bedrooms had furniture, lighting fixtures and personal storage space as required, mattress pads observed on all beds, the required amount of linen also observed. Bathrooms inspected were clean, operable, and furnished with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 109.1 to 113.9 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed. Signal systems were tested in resident rooms. The system was operable and staff responded to resident rooms within five minutes. Last Fire Drill was conducted 02/13/2022. Administrator certificate is current and expiration date is 06/12/2022. (-continued in LIC 8089C-) Sufficient supply of perishable and non-perishable foods was observed. Refrigerators, freezers, microwaves, ovens and counter tops observed to be clean. Sufficient supplies of plates, cups, glasses and utensils for the current census was observed. A comfortable temperature of 75 degrees Fahrenheit maintained throughout the entire facility. Smoke detectors and carbon monoxide detectors were tested and operable. Fire extinguishers were fully charged and last fire inspection was conducted on 01/21/22. Auditory alarm devices at exits were operable. First aid kits were fully stocked with manual. All mandated documents and signages were posted in common areas. There was shaded outdoor area with ample seating. No bodies of water observed. No deficiencies were cited per California Code of Regulations, Title 22. An exit interview was conducted. This report is discussed and provided to facility Licensee, Amber Branconier, whose signature on this form confirm receipt of these documents.