Routine inspection·June 28, 2021

Licensing Program Analyst (LPA) Albert Marin conducted an unannounced required annual inspection in this facility. LPA met with Administrator (AD) Amy Zuehl and stated the purpose of this visit. The facility is licensed for capacity of six non-ambulatory of which 1 may be bedridden; and with hospice waiver for four. For this visit, there was one resident under hospice care. At 10:15 AM, LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure of the facility. LPA observed six residents in care and three staff members on the floor. LPA toured the interior and exterior portions of the facility. There were four private and one shared resident’s rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Hardwired smoke, carbon monoxide and auditory exit alarms were observed to be operational. Bathrooms were provided with grab bars, and hot water was at 110 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. Exterior portion of the facility patio furniture observed in to be in good repair. Exterior exit door was self-closing and self-latching. For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with AD A. Zuehl; and copy of this report was left in the facility.