Routine inspection·March 6, 2024

Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 12:35PM to conduct an Annual Required inspection, and was greeted by staff. LPA met with Administrator, Leslie Wilson. LPA and Administrator discussed the purpose of the visit. LPA initiated a tour of the facility around 12:40PM and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in bathrooms used by residents measured at 115 and 116 degrees F which is within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cabinets containing cleaning supplies were locked. LPA observed drawer containing knives was unlocked. LPA and Administrator discussed getting a lock for the drawer. Facility has at least two days of perishable and one week of non-perishable foods which were of quality and stored per regulation. Medications were centrally stored and locked. Emergency food and water supplies are stored in the garage. Fire extinguishers were last serviced February 9, 2024. Smoke and carbon monoxide detectors located throughout the facility were tested and operational during inspection. Per conversation with Administrator, facility does not conduct fire/disaster drills. 2 staff files and 2 resident files were reviewed. Staff have required First Aid and CPR certificates. Training records were reviewed. Staff have required training. 2 of 2 residents did not have a required needs and services plan. 2 of 2 staff did not have a medical assessment or tuberculosis screening on file. Administrator Certificate for Administrator, Leslie Wilson (6020174740) is up to date and expires 05/07/2024. Medications and medication records were reviewed. Continued on LIC809C Continued from LIC809 Licensee/Administrator to submit updates of the following documents by 04/06/2024: LIC 500 Personnel Summary LIC 9020 Register of Residents Copy of Liability Insurance Emergency Disaster Plan (If any changes) Infection Control Plan (If any changes) 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, LIC809D, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on forms confirms receipt of documents.