Routine inspection·September 10, 2024

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1. During today’s visit, LPA met with Eric Lin, Administrator (AD). The facility is a single story building with six private rooms and an approved fire clearance of six non-ambulatory residents of which one may be bedridden . The facility is approved for six residents on hospice. Currently the facility has a census of six residents in care. with three on hospice. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in two of two resident bathrooms, and testing auditory devices on all exits . The hot water temperature measured between 111.5 and 113.7 d egrees Fahrenheit and all smoke detectors were operational . The fire extinguisher is charged and was serviced on September 10, 2024. The facility’s last fire drill was conducted on August 15, 2024. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand . L PA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. LPA reviewed four of four staff training and fingerprint records. One staff member was not associated with the facility and was immediately removed from work. An immediate civil penalty of $500 was assessed. LPA conducted a complete review of resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has an administrator certificate which is pending renewal which expired on 8/29/2024. Administrator is on the pending renewal list and will expire on August 29, 2026. (Continued on LIC 809-C) (Continued from LIC 809) The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Eric Lin, Administrator and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 809-D, LIC421IM and Appeal Rights.