Routine inspection·June 30, 2023

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 6/30/23 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are four bedrooms and one bathroom for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathroom was in sanitary condition and properly maintained. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPA checked medication storage and found medication to be locked away and inaccessible to the residents. LPA reviewed five (5) resident files and one (1) staff file. Facility has a current copy of certificate of liability insurance and LPA obtained a copy. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Section 87303 due to hot water temperature being observed to be 123 degrees F and 87458 regarding resident missing an LIC 602. Deficiencies are listed on 809-D. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Signatures on these forms acknowledges receipt of these documents.