Routine inspection·June 2, 2023

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski spoke with administrator Maria Kang over the phone and explained the purpose of the visit. Kang said she was unavailable but that co-administrator Jenny Duran would be able to sign this report in her absence. Kang's administrator certificate number is 6020167740 and it expires on 9/2/2024. LPA Moleski reviewed three resident files (R1-R3) and three staff files (S1-S3). LPA Moleski reviewed LIS and discovered that S1 had not been associated to this facility. Duran said she had incorrectly associated her to the facility's former number, not the current facility number. R1's LIC 602 indicated that R1 has dementia. R1's latest LIC 602 form was dated 5/14/21, which is more than one year old. LPA Moleski toured the facility with Duran and inspected common areas, the kitchen, resident bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 73 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature was tested and measured 105 degrees Fahrenheit, which is within the required range of 105 and 120 degrees. [Continued on 809-C] LPA Moleski observed a first aid kit, a fully-charged and up-to-date fire extinguisher, and working carbon monoxide/smoke detectors. LPA Moleski observed the required minimum 2-day perishable supply of food and a minimum 7-day supply of nonperishable food. LPA Moleski observed locked cabinets for the storage of medication. LPA Moleski observed a locked closet for the storage of cleaning solutions. LPA Moleski observed a locked cabinet for the storage of knives. LPA Moleski interviewed two staff members (S1, S3) and two residents (R4, R5). This facility is being cited per 22 CCR Section 87355(e)(3) and 87705(c)(5). An exit interview was held with Duran. Appeal rights and a copy of this report were left with Duran.