Routine inspection·June 25, 2021

On 06/25/21 at 2:15pm Licensing Program Analyst (LPA) Kevin Gould arrived at Country Club Manor for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Maria Ciscoe and together conducted a tour of the facility. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 93.5 degrees F in room #6 and 130 degrees F which does not meet the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report, LIC 610E Emergency Disaster Plan, Current Administrator Certificate and Client Roster The following deficiencies were observed and cited Per California Code of Regulations, Title 22 during today's inspection. An exit interview was conducted, a copy of this report and appeal rights was left at the facility.