Routine inspection·September 20, 2023

On 9/20/2023, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection visit. LPA met with Administrator Kasie Wimmer and explained the purpose of the visit. Administrator holds certification # 6034525740 and has expired on 5/21/2023. Renewal application is currently pending. The facility is licensed to serve (99) non-ambulatory residents. Hospice waiver approved for (15). There are (49) residents in care currently. LPA toured and inspected the physical plant inside and outside to ensure there were no health and safety concerns. LPA observed the lounge area, lobby, and common areas. In addition, the kitchen areas, dining area, and activity room was toured. Medication room was toured. Kitchen was toured for adequate food supplies and storage. A review of the facility perimeter fence, side gates, and exits was conducted. A review of the resident rooms was conducted. LPA observed the facility to be free of odor, clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The hot water temperature was measured at 122.5*F in room #120 and 124.0*F in room #103. The temperature inside the facility measured at 73.0 degrees Fahrenheit. LPA observed centrally stored medications, toxins, and sharp knives kept locked and inaccessible to residents. LPA observed the fire extinguisher(s) were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. First aid kit was checked and is complete. Proof of current liability insurance was observed. Continue on 809-C LPA requested resident and staff files for review. LPA reviewed (3) resident files and (3) staff files, including criminal record clearances. A review of staff records indicates that 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. The following documents was obtained during today's visit: LIC 308 Designation of Administrative Responsibility, Administrator Certificate, and Proof of current Liability Insurance. The following forms and documents were requested to be submitted within 15 days: LIC 500 Personnel Report, LIC 610 Emergency Disaster Plan. Per California Code of Regulations, Title 22, deficiencies are being cited on the attached 809-D during this visit. Exit interview was conducted, a copy of this report, LIC 809-D and Appeal Rights were left at the facility.