Routine inspection·November 16, 2023

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required annual inspection visit. LPA met with administrator and explained the purpose of the visit. Administrator certificate #6043428740 expires on 01/25/2023. This facility is a single story building licensed to serve six non-ambulatory residents and has a hospice waiver for two residents. LPA and staff toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 112.8 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher last serviced 7/6/2023. Thermostat observed at 75 degrees Fahrenheit. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to residents. LPA reviewed three resident files and three staff files. A review of staff records indicates that all facility staff & other individuals who require caregiver background checks are fingerprint cleared and to the facility. LPA verified staff training for staff file reviews and all three staff have current First Aid Certificates. LPA requested the following updated documents to be submitted via email to community care licensing by 12/4/2023: LIC 308 - Designation of Administrator, LIC 500 - Personnel Report, copy of administrator's certificate, and liability insurance. ruth.wallace@dss.ca.gov Per the California Code of Regulations, Title 22 no deficiencies were observed or cited. Exit interview held with administrator. A report and LIC 811 (Confidential Names) was left at the facility.