Routine inspection·September 23, 2024

At approximately 1:40PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Staff Member, Angel Socito. Administrator, Rufus Zingkhai arrived during visit at approximately 2:00PM. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and total capacity for 30 non-ambulatory residents and has an approved hospice waiver for 6 individuals. Upon arrival, LPA was informed that there were 16 Residents in care and 3 staff members on-site. At approximately 1:50PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 1:55PM, LPA conducted a walk-though of the facility with Staff Member. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a 1 story building with 15 Resident bedrooms, 8 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Hot water temperatures for a sample size of 4 sinks were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility's last emergency/disaster drill was conducted September 2024. Facility's fire extinguishers were last inspected August 2024. Facility has a hard wired fire alarm and sprinkler system that is directly connected to the local Fire Department. Facility's smoke detectors and sprinkler system were last inspected August 2024. Facility's carbon monoxide detectors were tested and operational. Continued on LIC809C Continued from LIC809 During walkthrough, LPA was informed that Facility currently has 1 resident with bedridden status . Facility currently does not have a clearance to admit residents with bedridden status. Licensee to submit a new LIC200 and updated facility sketch to Community Care Licensing (CCL) so a new fire clearance can be requested (deficiency cited, see LIC809D, regulation 87202(a)(2)). Licensee understands that if a new fire clearance is not granted by the local Fire Department, the resident will have to be relocated due to requiring a higher level of care. LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D (Deficiency Page), Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.