Routine inspection·October 30, 2023

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 10/30/23 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA spoke with Assistant Administrator, Juan Ramirez, via telephone call, who gave permission to have caregiver, Geneva Campbell, sign report. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are five (5) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. Bathrooms were in sanitary condition and properly maintained. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed smoke detectors to be operational in the care home. LPA checked medication storage and found medication to be locked away and inaccessible to the residents. LPA reviewed three (3) resident files and two (2) staff files. LPA requested a copy of the facility's certificate of liability insurance. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Section 87203 regarding fire extinguishers not being serviced and carbon monoxide detectors not being operational, Section 87303(e)(2) for hot water temperature being observed at 123 degrees F, and 87303(a) for disrepair of the facility. Deficiencies are listed on 809-D. An immediate civil penalty per Health and Safety Code § 1548 in the amount of $500 for the date of 10/30/2023 is assessed for a violation that the department determines was a fire clearance violation. Exit interview was conducted with Licensee. A copy of this report and appeal rights were provided. Signatures on these forms acknowledges receipt of these documents.