Routine inspection·December 11, 2024

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. The facility is licensed for a capacity of 6 non-ambulatory residents with a hospice waiver for 3. LPA observed the See Something, Say Something sign measured 17 by 11 inches. LPA observed all the required postings in the main entry way of the facility. Facility has 6 bedrooms, 5 bathrooms, living room, dining room, kitchen and a 2 car garage. LPA and staff toured the facility. LPA observed the fireplace in the dining room and the fireplace in the living room are screened. LPA observed all resident rooms are clean and organized. All resident rooms had the required furnishings. LPA observed all bathrooms are clean and operational. Hot water measured between 107.5 to 117.7 degrees Fahrenheit in all 5 bathrooms. LPA toured the kitchen. The kitchen is organized and clean. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. Knives are kept locked in a kitchen drawer. Cleaning supplies are kept locked under the kitchen sink. LPA observed the fire extinguisher in the kitchen is fully charged. Smoke detectors/carbon monoxide detectors tested operational. LPA toured the backyard. No bodies of water observed. There is a covered patio with shaded seating for residents to sit outside. Both exit gates are operational. No obstacles or hazards observed in the backyard. LPA reviewed staff files. LPA observed 3 out of 3 staff members have background clearances but not all staff are associated to the facility. Staff 1 is associated to the facility, but Staff 2 and Staff 3 are not associated to the facility. LPA observed Staff 2 and Staff 3 leave the facility. LPA observed Staff 1 did not have any current training except CPR training. LPA reviewed 5 resident records, no discrepancies observed. LPA reviewed 5 resident medications, no discrepancies observed. LPA observed and staff verified there is no internet device for dedicated resident use. LPA reviewed facility documents, there is no evidence of any emergency drills being conducted for the staff. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Civil penalty assessed on today's date. An exit interview was conducted with the facility representative and a copy of the report, along with appeal rights and civil penalty was provided to the facility representative.