Routine inspection·April 20, 2023

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection on March 30, 2023. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction, visit purpose and provided the facility with LPA identification and business card. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured at 119-120 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications. LPA verified there is a telephone working at this location. LPA interviewed five (5) residents and three (3) staff. Due to time constraints, Inspection will need to be concluded at another time. The following domains were completed today: Infection Control, Operational Requirements, Physical Plant & Environmental Safety, Planned Activities and Food Services completed. Based on the information received during this visit today, no deficiency being cited per Title 22, Division 6 of The California Code of Regulations. This report was reviewed with and a copy provided to the facility representative. On this day, April 20, 2023, LPA Delgado arrived unannounced to complete the annual inspection. Resident record review began. Two (2) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. (Continued on LIC809-C) (CONTINUED FROM LIC809) Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. LPA began review of employee records. Two (2) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the garage has temporary walls with two beds and bedroom furniture and it is not on the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 3/30/2023. The facility is conducting emergency disaster drills however not quarter to quarter. The last disaster drill was conducted on 02/26/2023. All domains have been completed. Based on the information received during this visit today, there were two (2) deficiencies is being cited per Title 22, Division 6 of The California Code of Regulations. This report, 809-D, and Appeal Rights was reviewed with and a copy will be emailed and a confirmed receipt will be requested by the facility representative.