Routine inspection·August 17, 2023

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Inspection Visit. LPA met with administrator and explained purpose of visit. Fire clearance was granted on 6/5/19 for 4 ambulatory and 2 non-ambulatory clients. Administrator certificate expires March 24, 2024. LPA and administrator conducted a tour inside and outside the facility. LPA observed the back yard with secure fence and no pool or body of water observed. LPA observed all hallways and passageways to be free of clutter or hazards. LPA observed bedrooms and living areas to be adequately furnished. The temperature inside the facility was observed to be at 71*F which is within the required range of 68-85*F. The hot water temperature was measured at 109.7*F which is within the required range of 105-120*F. LPA observed a pull alarm system, fire extinguisher(s) last inspected on January 1, 2023, smoke and carbon monoxide detectors, and central heating and air in the facility. All Fire Exits are free of obstacles and last fire drill was completed on June 26, 2023. LPA observed two day perishables and seven day non-perishables. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items. LPA observed bathroom facilities to be functioning properly. Cleaning supplies and chemicals are stored in a locked cabinet. Medications and confidential paperwork will be stored in a locked cabinet. Night staff must be awake. Activity supplies available. LPA reviewed two staff and two resident files. Resident emergency contact complete. LPA observed all staff and resident files complete. All staff have criminal record clearance and are associated to the facility. Continued on 809-C Page 2 Continued from 809 - Page 2 LPA received the following updated documents for master file in CCL on today's date: Designation of Facility Responsibility (LIC 308), Liability Insurance, and Administrator Certificate. Licensee is going to request technical assistance from Licensing Program Manager Stephen Richardson. Department Of Social Services Community Care Licensing Division 9835 Goethe Rd, Ste 100, Sacramento, CA 95827 LPA received the following updated documents for master file in CCL on today's date: Designation of Facility Responsibility (LIC 308), Liability Insurance, and Administrator Certificate. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held with administrator. A copy of report and LIC 811 (Confidential Names) left at facility.