Routine inspection·April 14, 2024

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection visit. LPA met with administrator and stated the purpose of today’s visit. The facility is licensed for six non-ambulatory resident and has an approved hospice waiver for four. LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. The facility is sanitary and furnished. All resident rooms are furnished and in good repair, and the resident bathrooms are sanitary and furnished. The laundry is room is sanitary and laundry is done daily. All toxins are kept locked and made inaccessible to residents in care. LPA observed grab bars and non-skid flooring in all bathrooms. Fire extinguishers were last inspected 2/7/2024. The facility conducts fire/disaster drills with residents on 3/4/2024. Smoke/monoxide alarms are working order. LPA observed a complete First Aid kit on site. LPA measured the hot water temperature in resident's bathroom at 111.2 degrees Fahrenheit which is within the required range of 105 to 120 degrees. LPA observed all doors to have alarms. LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA observed seating on patio and two gates that were locked and accessible. LPA reviewed three resident files and four staff files, including criminal record clearances. A review of staff records indicates all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. LPA requested the following updated documents for community care licensing to be submitted via email by May 15, 2024: LIC 308 Designation of Administrator, LIC 500 - Personnel Report, LIC 610E Emergency Disaster Plan, Copy of Administrator's Certificate, and Copy of Liability Insurance. ruth.wallace@dss.ca.gov Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies are being cited. Exit interview conducted with administrator. Copy of reports and (LIC 811 Confidential Names) left at facility.