Routine inspection·September 6, 2022

On 09/06/2022 at 2:30pm, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection focusing on Infection Control procedures. LPA was greeted and granted entry by administrator Troy Ujimori and Mila Ujimori and explained the purpose of the visit. At approximately 2:45pm, LPA accompanied by administrators toured the physical plant of the facility. There are currently three (3) residents in care, all of which are receiving hospice care, which is in compliance with the terms of the approved hospice waiver. Residents are observed relaxing in the common areas or in their respective bedrooms and appear clean and well taken care of. The currently occupied bedrooms include all necessary components. A fifth bedroom is currently not in use and not furnished pending an upcoming admission for which a hospital bed will be installed by the resident's family. A sixth bedroom is currently not being used by residents but used as a staff bedroom and storage area. A Technical Advisory is issued by the LPA regarding the furnishing requirements. Bathrooms are equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected. Sharp instruments and cleaning supplies are stored securely with child-proofing mechanisms. The centrally stored medication is located in the entrance hallway in locked closet. A laundry area along with detergent are observed in the locked attached garage. LPA observed a sufficient supply of food and water present. LPA observed the facility has COVID-19 Precautions posters and all required department postings. Staff present is adequately cleared and associated in Guardian. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 The fire extinguisher present is mounted and charged but was inspected in March 2021, which means that it should have been reinspected in March 2022 at the latest. A Technical Violation is issued in regards to the fire extinguisher required maintenance. The posted administrator certificate is shown to be out-of-date, however administrator was able to provide documentation of the required coursework and valid certification during the visit. LPA provides consultation on the necessity to replace the posted document with a valid copy. LPA and administrator toured the outside of the facility and observed it to be free of obstructions. Outdoor furniture and a shaded area are present for the enjoyment of residents and visitors. The perimeter gates on both sides of the facility are self-latching and can easily be opened in an evacuation. 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. A Technical Violation advisory is issued in regard to the fire extinguisher's maintenance status. A Technical Advisory is additionally issued regarding the furnishing requirements in a residential care facility for the elderly. This report was reviewed with facility representative and a copy of this report was provided and left at facility.