Routine inspection·January 3, 2024

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced required 1 year annual inspection visit. LPA met with administrator and explained the purpose of the visit. Administrator assisted LPA for inspection visit on today's date. LPA inspected the physical plant including, but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. This facility is a single story building licensed to serve four (6) non-ambulatory residents and (2) hospice waiver. LPA observed the facility to be free of odor and clean. LPA observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. The furniture is spaced six feet apart, and the facility does daily cleaning. LPA observed an insufficient supply of food in the two day perishables; missing vegetables, dairy products, bread, and fruit. The hot water temperature was measured at 110.7*F in kitchen sink and is within the required range of 105-120*F. The temperature inside the facility measured at 75*F which was within the required range of 68-85*F. The facility smoke and carbon detectors are in good repair. Fire extinguishers last inspected on 2/2/2023. The facility has a first aid kit, and the medications are stored in a locked cabinet. LPA toured the exterior of the facility. LPA reviewed four resident files and four staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. The following documents shall be submitted to LPA Wallace by 01/17/2024: LIC 308 Designation of Administrative Responsibility, LIC 500 Personnel Report, Copy of Administrator Certificate, and Proof of Current Liability Insurance. ruth.wallace@dss.ca.gov Per the California Code of Regulations, Title 22, Division 6, Chapter 6, see violation cited during this visit. Exit interview held with administrator. A copy of LIC 809, LIC 809-D, LIC 811 (Confidential Names), and Appeal Rights left at facility.