Routine inspection·July 6, 2023

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 7/6/23 at 2:20pm. Administrator Certificate expired 1/30/2023, however, the pertinent documents and fees were submitted to Community Care Licensing and the updated certificate has not been received yet. License fees are current. LPA met with Patricia Matias, Administrator and discussed the purpose of the visit. The facility is licensed for a capacity of 6 non-ambulatory residents of which 1 maybe bedridden in room #3 only. LPA observed 2-day perishables and 7-day non-perishables. There is a hospice waiver for 2 but 0 are receiving the services at this time. The temperature inside the facility was observed to be at 74*F which is within the required range of 68-85*F. The hot water temperature was measured at 108.8 *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. 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) in accordance to Title 22 regulations Personnel Report (LIC500) with complete dates LIC308 and LIC500 to indicate 24/7 coverage following the Dept of Labor laws Administrator Certificate-Updated Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies cited during this visit. Exit interview held, copy of report given