Routine inspection·May 19, 2022

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - Annual visit on 5/19/22 at 11:28AM. Administrator Certificate expires 11/24/2023. LPA met with Maria Pena, Caregiver and Administrator Aeleah Mc Donald arrived within 5 minutes. LPA stated the purpose of the visit. The facility is licensed for a capacity of 6 Non-ambulatory. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 72*F which is within the required range of 68-85*F. The hot water temperature was measured at 113.7*F which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. Facility has hospice waiver for 3 of which there are 0 residents receiving hospice services at this time. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Facility Responsibility (LIC308) Liability Insurance Personnel Report (LIC500) Administrator Certificate-Updated Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, copy of report given