Routine inspection·November 16, 2023

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required annual inspection visit. LPA met with House Manager and explained purpose of visit. Administrator certificate expires on 11/8/2024. The facility is licensed to served six non-ambulatory residents. Hospice waiver approved for four residents. There are currently six residents and no residents are on hospice at this time. LPA and house manager inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry area, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. Hot water temperature was observed to be 114.5 degrees Fahrenheit. Facility thermostat observed at 75 degrees Fahrenheit. Food supply is adequate for two day perishable and seven day nonperishable. LPA observed knives and toxins to be locked away and inaccessible to clients. Smoke and carbon detectors were in good repair. Fire extinguisher was last inspected on 11/17/2022 and first aid kit was current. LPA checked medication storage and found medication to be locked away and inaccessible to residents. The facility mitigation plan was submitted to community care licensing and it was approved on 2/16/2021. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed four resident and four staff files, including criminal record clearances. All staff are fingerprint cleared and associated to the facility. First aid kit was checked and is complete. LPA requested the following updated documents to be submitted via email to community care licensing by 12/4/2023: LIC 308 - Designation of Administrator, copy of deed, 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 house manager. A report and LIC 811 (Confidential Names) was left at the facility.