Routine inspection·July 12, 2021

Licensing Program Analyst (LPA) Albert Marin conducted an unannounced required annual inspection in this facility. LPA met with Administrator (AD) Tyana Fisk and stated the purpose of this visit. The facility is licensed for capacity of six non-ambulatory and with hospice waiver for three. For this visit, there were three residents under hospice care. About 1:26 PM, LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. LPA observed six residents in care and two staff members LPA toured the interior and exterior portions of the facility. There were six private resident’s rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke, carbon monoxide and auditory exit alarms were tested to be operational. Bathrooms were provided with grab bars; non-skid floor mats, and hot water was measured at 105 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguisher was mounted and charged. For the exterior portion of the facility, patio furniture were observed in to be in good repair, and grounds were free of tripping hazards. Exterior exit door was self-closing and self-latching. LPA reviewed the COVID 19 mitigation plan of the facility. For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations. LPA Marin conducted an exit interview with AD Tyana Fisk and copy of this report was left in the facility.