Routine inspection·April 24, 2022

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit April 24, 2022 at 9:00 a.m. for the facility’s annual inspection. LPA met with Administrator Michael Hagerty, Continual Administrator's Certification expires 09/03/2023. There are currently 5 residents who reside at this home and there is 3 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, medication storage, kitchen, and outdoor areas. Bedrooms were clean and in good repair. LPA observed sufficient supply of bedding linens in facility closet. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed resident as needed PRN medications not being logged in Medication Administration Record. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 109 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. LPA observed all staff working is background cleared. LPA reviewed staff files and all have vaccine exemption forms or vaccination records. The following deficiencies were cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Administrator Michael Hagerty and copy of report left at facility