Routine inspection·July 6, 2023

On 7/6/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced at the facility to conduct a Required Annual Inspection. LPA met with Licensee Miriam Fickerwirth and Co-Administrator Michael Hagerty. LPA toured the facility inside and outside. Pathways and doors were clear and free from obstruction. Smoke-detectors and carbon-monoxide detectors were present and operational. Facility was clean and odor free. LPA observed sufficient amount of perishable and non-perishable foodstuffs. Common areas were clean, adequately furnished, and adequately lit. Resident bedrooms were clean and had required minimum furnishings. Resident bathrooms were clean, odor free, and water temperature was within required temperature range. Sharp items were secured in a locked drawer. A locked cabinet was observed to store resident medications, and medications appeared to be administered properly. LPA reviewed facility plan of operations and emergency disaster plan. LPA reviewed a sample of resident files. During Records Review, LPA observed that Resident 1, who was diagnosed with dementia, had a most recent physician's report LIC 602A which was dated 5/25/2021. See attached 809D for deficiency cited in accordance with California Code of Regulations Title 22, Division 6, chapter 8, Article 12, Section 87705(c)(5). LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan, and a copy of current Administrator’s Certificate to update the facility file. Exit interview conducted with Licensee and a copy of the report and appeal rights were provided.