Routine inspection·November 9, 2021

Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to conduct required annual inspection in this facility. . LPA met with Administrator (AD) Josephine "Josie" Teehankee and stated the purpose of the visit. About 12:50 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 on the floor. This single level structure is licensed for six non-ambulatory of which one may be bedridden and with hospice waiver for four. For this visit, there were three residents under hospice care and three residents under home health for physical therapy and health maintenance. About 1:00 PM, LPA Marin conducted a tour in the interior and exterior portions of the facility. LPA observed six private resident's rooms. Rooms were provided with clean linens, furniture in good repair, adequate storage space and cleared of tripping hazards. One common bathroom was provided with grab bars and non skid floor mat. Hot water was measured at 110 degrees Fahrenheit. Smoke, carbon monoxide and auditory exit alarms were tested to be operational. Fire extinguisher was mounted and charged. Medications, cleaning supplies, sharp items were inaccessible to residents in care. Facility met the minimum 2 day perishable and 7 day non perishable food stock requirement. For the exterior portion, facility had patio furniture in good repair, and grounds were free of tripping hazards,. Side exit doors were self-closing and self-latching. LPA Marin 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 Teehankee; and copy of this report was left in the facility.