Routine inspection·September 19, 2023

At approximately 1:30PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Administrator, Justine Herrera. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance for 5 non-ambulatory and 1 bedridden resident for a total capacity of 6 residents. Facility has an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were 6 Residents in care and 3 staff on-site. At approximately 1:35PM, 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 1:40PM, LPA conducted a walk-though of the facility with Administrator. 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 6 Resident bedrooms, 3 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. During walk-through, LPA observed that hot water temperatures for 3 of 6 sinks in facility were out of Title 22 regulations of 105 to 120 degrees Fahrenheit, measuring at 121.6F, 121.8F, and 123.6F (This deficiency has been cited, see LIC809D, Regulation 87303(e)(2)). Facility's fire extinguishers were last inspected August 2023. Facility smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency drill was conducted March 2023 (See Technical Violation, LIC9102, Health and Safety Code 1569.695(c)). At approximately 2:10AM, LPA reviewed staff files. Staff Files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date. Continued on LIC809C Continued from LIC809 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), LIC9102 (Technical Advisory/Violation), Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.