Routine inspection·June 20, 2023

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 6/20/23 to conduct a Required-1 Year Inspe ction utilizing the inspection tool. Licensee gave permission to have caregiver, Hazel Adassa H. Minott , sign additi onal pages to the report. 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. Bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 116 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 knives, cleaning products, and other toxins to be locked away and inaccessible to residents. 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. 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 five resident files and three staff files. Facility has a current copy of certificate of liability insurance and LPA requested a copy. As a result of today's inspection, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Section 87203 regarding fire extinguishers not being serviced and carbon monoxide detectors not being installed. Deficiency is listed on 809-D. An immediate civil penalty per Health and Safety Code § 1548 in the amount of $500 for the date of 6/20/2023 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.