Routine inspection·October 7, 2022

On 10/07/2022 at 1:00pm, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection mostly focused on Infection Control procedures. LPA was greeted and granted entry by caregiving staff after undergoing the COVID-19 screening procedure and explaining the purpose of the visit. Administrator Brigitte Fisk was notified by phone and arrived shortly afterwards to assist with the visit. At approximately 1:25pm, LPA accompanied by administrator toured the physical plant of the facility. There are currently six (6) residents in care, two (2) of which are receiving hospice care. Residents are observed relaxing in their respective bedrooms or in the facility's common areas. All appear clean and well taken care of. The bedrooms include all necessary components of furnishing. Bathrooms are equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected. An ample supply of linen is observed. Sharp instruments are kept in a locking box on the kitchen counter. Cleaning supplies are located in the attached garage which is equipped with a code keyless entry. The centrally stored medication is located in a locked cabinet in the dining room. LPA observed a sufficient supply of food and water present. LPA observed the facility has COVID-19 Precautions posters and all required department postings along with hand washing signs. The fire extinguisher present is charged and has up-to-date maintenance shown on the attached tag. Staff present is adequately cleared and associated in Guardian. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA and administrator toured the outside of the facility and observed it to be free of obstructions. Outdoor furniture and multiple shaded areas are present in the backyard for the enjoyment of residents and visitors. The facility exit route are clear. There are no bodies of water on the premises. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report along was provided and left at facility.