Routine inspection·August 7, 2023

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual required 1 – year inspection visit of the facility. LPA was welcomed by CEO Hunter Moore, COO/Administrator Kyle Ruth-Islas arrived shortly after. There is a total of 124 residents, 9 of which have dementia diagnosis. There are 3 residents currently on Hospice. LPA toured the facility on 8/7/2023 at 8:45 AM with Administrator Kyle Ruth-Islas; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguishers were found to be last charged on 1/11/2023 at the time of the visit. Facility hallway smoke detectors are hard wired and sound directly to the fire station. Smoke detectors, carbon monoxide, and fire sprinklers are inspected, and inspection records are current with the last inspection being conducted on 4/6/2023. There are emergency lights in many of the fixtures in the common areas of the facility that come on should a power outage occur. Hot water temperature measured between 113.7 degrees F and 135.5 degrees F falling out of Title 22 acceptable regulation of 105 to 120 degrees F in 5 of 7 resident’s faucet bathrooms while touring facility on 8/7/2023 at 9:45 AM (see LIC809D). Facility serves residents with dementia and has special care plan of operation and programming. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations at the time of the visit. LPA toured the kitchen area on 8/7/2023 at 9:00 AM with Administrator Kyle Ruth-Islas and learned that there are provisions made for individuals/residents with special dietary needs. Facility kitchen has resident’s names and their needs. Food is available for residents any time of the day. There is a daily activity schedule for residents. Toxins are stored in a locked housekeeping room. There was a supply of cleaners, hygiene products and paper products available for residents. (Continue LIC 809-C) Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. A sample of eight resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing. LPA is advising facility to ensure that beds are outfitted with mattress pads as required by Title 22 Regulations. A sample review of five resident & seven staff records was conducted. LPA reviewed resident’s files at 12:00 PM on 8/7/2023 and learned that 5 out of 5 residents have an updated reappraisal/needs & care plan on file as well as medical assessments at this time as required by Title 22 Regulation. Medications were centrally stored in a locked medication cart in the facility medication room. LPA conducted a sample reviewed of staff records at 1:15 PM on 8/7/2023 and learned that all facility staff and other individuals who require caregiver background checks have received criminal record clearances or exemptions. In addition, Direct care staff have received the additional training requirements as per Title 22 Regulations and H&S Code. LPA was presented with proof of CPR & 1 st Aid certification for all staff. LPA reviewed Licensing Information System (LIS) with administrator who stated that is corrected and updated at this time; no need to change any of the information other than email. Disaster Drills are conducted quarterly with the last one being conducted on 7/12//2023. Facility has just finished installation of full cite emergency generator. Kyle Ruth-Islas Administrator Certificate # 6029464740 expires on 1/15/2024. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. (Continue LIC 809-C) LPA Hansen is requesting Licensee to update the following documents and submit to CCL by 9/1/2023: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurance