Routine inspection·March 14, 2024

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 3/14/24 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and three (3) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 115.6 degrees F. 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 and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. 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. Facility has a current copy of certificate of liability insurance and LPA requested a copy. 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, Section 87309(a) regarding chemicals being accessible to residents, and Section 87615(a) regarding acceptance and retention of a resident with a prohibited health condition without an exception from CCLD. Deficiencies are listed on 809-D. Exit interview was conducted with caregiver. A copy of this report and appeal rights were provided. Signatures on these forms acknowledges receipt of these documents.