Routine inspection·May 26, 2023

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with staff#2 (S2) and Licensee/administrator, Amber Branconier and discussed the purpose of today's 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 Waiver on file. Currently, one (1) resident is on hospice. Annual licensing fees are current. During the visit, the CARE tool was used, physical plant/facility tour was conducted, food supply was reviewed, staff/residents’ files were reviewed, and medications were reviewed. The facility is located at the residential area. The premise is a two-story building with 60 resident rooms. Facility consists 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 are centrally stored and locked in the medication room. Medication records are current. Hallways were clean and free of obstructions. Common areas were well organized and free of hazards. Hazardous items are locked and inaccessible to residents in care. LPA inspected 10 (ten) residents’ rooms of room#103, #107, #109, #203, #204, #207, #211, #212, #233 and #237. Resident bedrooms had furniture, lighting fixture and personal storage space as required. Mattress pads were 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 108.8 to 115.5 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed. (-continued in LIC 809C-) Signal systems were tested in resident rooms. The system was functional and staff responded to resident rooms within five minutes. Last fire inspection and facility fire drill were conducted on 03/17/23. Sufficient supplies of perishable and non-perishable foods were 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 74 degrees Fahrenheit maintained throughout the entire facility. Smoke detectors and carbon monoxide detectors were tested and operational. Fire extinguishers were fully charged and last fire inspection was conducted on 03/17/23. Auditory alarm devices at exits were working. First aid kits were fully stocked with manual. All mandated documents and signages are posted in common areas. There is shaded outdoor area with ample seating. No bodies of water observed. Deficiencies were cited per California Code of Regulations, Title 22. Administrator certificate is not current and facility did not have a qualified administrator. See LIC 809D for details. An exit interview was conducted. This report and appeal rights were discussed and provided to facility Licensee, whose signature on this form confirm receipt of these documents.