Routine inspection·December 12, 2024

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrators Andrew Beach, Patricia Beach and Nancy Ayala were notified of the visit via telephone and arrived later to assist. LPA accompanied by facility staff conducted a tour of the physical plant and observed the following: the facility is a one-story home with an attached garage. The facility has a total of six single bedrooms in addition to a staff room. There are five en-suite bathrooms and one en-suite bathroom in the facility. All bathrooms are observed to be equipped with grab bars and slip mats. All resident bedrooms have the required furnishings. Bathrooms faucets and toilets are operational. Water temperature was measured at 114F in the shared bathroom used for personal hygiene. LPA observed all beds have linen and blankets. There are currently six residents admitted to the facility, none of which is receiving hospice care. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Drills have been conducted quarterly in 2024 with documentation to be provided by licensee via email. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke and carbon monoxide detectors tested operational. Fire extinguishers present are fully charged and have been maintained in 2024. There is adequately shaded outside space with outdoor furniture present. There are self-latching gates on each side of the property. The routes of egress on both sides are free of obstructions. There are no bodies of water on the premises. Cleaning products are observed to placed in a cabinet under the kitchen sink, lock appears to be missing. The medication central storage is in a cabinet in the kitchen also, however the lock on the right door is not functional as observed during the visit. Type B citation issued. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Medication central storage reviewed for accuracy. No discrepancies observed with the physician orders on file. LPA reviewed six resident files along with three staff files. Two physician reports for residents diagnosed with dementia have been established in October 2023 and will need to be updated. Technical Violation Advisory Note issued. Resident records otherwise include all necessary components. All staff members present are confirmed to have received background clearance. Training verified to be up to date. CPR training documentation on file. Health screenings are on file for staff members reviewed. Based on the observations made during today’s inspection, one type B deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. One Technical Violation and one Technical Assistance Advisory Notes issued regarding physician report updates An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.