Routine inspection·April 20, 2023

Licensing Program Analysts (LPA's) Ruth Wallace and Pang Lee conducted an unannounced Required 1 Year Annual Inspection Visit. LPA's met with Administrator and explained the purpose of the visit. Administrator Certificate expires on 07/15/2024. This facility is a single story building licensed to serve six (6) non-ambulatory residents, and licensed to serve up to 3 residents with a hospice waiver. Facility has 1 shared room and 4 private rooms. LPA's toured with Administrator the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA's observed the facility to be free of odor, clean and in good repair. LPA's observed sufficient furniture and lighting throughout the facility. There are no bodies of water present. LPA's observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 106.2 degrees Fahrenheit in the kitchen sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers expire 4/5/2024 and smoke detectors are in compliance with fire safety. LPA's observed linen closets to be stocked. LPA's observed centrally stored medications and toxins was kept locked and inaccessible to residents. LPA's reviewed 2 resident and 3 staff records. LPA's staff associations to the facility. First aid kit was checked and is complete. A full Care Tool Inspection was completed at facility. Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. Exit interview held with Administrator and a copy of report given at the conclusion of the visit.