Routine inspection·November 17, 2021

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced annual required visit on 11/17/2021 at 12:30 PM. LPA met with the Administrator and explained purpose of the visit. LPA toured the facility and inspected physical plant including but not limited to kitchen, bedrooms, bathrooms, living and dining room area. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA observed the Fire extinguisher expired on 09/11/2021 and smoke detectors are current and in compliance with fire safety. Carbon dioxide monitor present and in working order. LPA observed centrally stored medications, knives and toxins locked and not accessible to residents. LPA reviewed 3 resident and 3 staff files, including criminal record clearances. All staff today are Fingerprint cleared and associated to the facility. First aid/CPR certificates are current. First aid kit was checked and is complete. The following documents needed to be submitted to licensing by January 11, 2022: Admissions Polices and Procedures, Control of Property - Lease, Health Screening Report -Copy, Job Descriptions/Personnel Policies, Liability Insurance, Plan for Incidental Medical and Dental Care, Plan of Operation, Theft and Loss Policy and Procedures, Transportation Procedures, Administrator Certificate, and a copy of Liability Insurance LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency is being cited. See 809-D for citation. Immediate civil penalty of $500.00 was issued to facility. Failure to correct the deficiency by the noted due date may result in an additional penalty being assessed. Exit interview held and a report left at facility.