Routine inspection·January 9, 2023

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Annual Inspection Visit. LPA was screened prior to being allowed entry into the home and explained purpose of visit to direct care staff. LPA and direct care staff toured physical plant inside and outside to ensure the safety of the residents and compliance with Title 22 regulations. There were no observed health or safety concerns. LPA conducted the infection control domain tool. The facility has one central entry point and has implemented screening and sign in procedures at the front of the home. LPA observed the facility to have COVID-19 informational and hand washing signs posted at the front door and throughout the facility. The facility has seven (7) non-ambulatory and one (1) ambulatory residents. LPA observed the temperature inside the facility was measured at 72*F, which is within the required range of 68 degrees F and 85 degrees F. The hot water was measured at 110.3*F, which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C) as per Title 22 regulations. Facility has nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA observed the centrally stored medications area and cleaning supplies to be locked and inaccessible to clients. Resident rooms was sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguishers were last inspected on 4/31/2022. LPA reviewed two (2) staff records and two (2) resident records. All files were complete. Staff are fingerprint cleared and first aid certified. Liability Insurance expires 3/1/2023. LPA observed medications and the MARS sheets. Medications appear to be documented appropriately. LPA requested the following updated documents to be emailed by February 6, 2023: Administrator Certificate, Liability Insurance, LIC 308 - Designation of Administrative Responsibility, and LIC 610-E Emergency Disaster Plan. Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during this visit. An exit interview was held with direct care staff and a copy of the report was left at facility.