Routine inspection·June 6, 2022

Licensing Program Analysts (LPA's) Ruth Wallace and Renee Campbell conducted an unannounced 1 Year Required Annual Inspection Visit.. LPA's met with Administrator and explained the purpose of the visit. Administrator Certificate #60564441740 expires on 06/30/23 This facility is a single story building licensed to serve six (6) non-ambulatory residents and has a waiver for 1 hospice. There is 1 resident on hospice currently. LPA's toured 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. In hospice resident room there was a lazy boy chair and wheelchair in front of exit door to outside. 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 106.5 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguishers were serviced and expired 06/04/2022 Thermostat observed at (74.0) degrees Fahrenheit. LPA's observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to clients. LPA's reviewed (3) resident and staff files, including criminal record clearances. LPA's reviewed staff associations to the facility. First aid kit was checked and is complete. The following documents to be submitted to CCL via email to LPA by 06/30/22: LIC 308 - Designation of Administrative Responsibility, LIC 500 - Personnel Summary, LIC 610-E Emergency Disaster Plan, and Copy of liability insurance Per California Code of Regulations, Title 22 Division 6, Chapter 8, two deficiencies were cited. Exit interview held with Administrator and a copy of reports/appeals given at the conclusion of the visit.