Routine inspection·March 23, 2023

On 3/23/23 at approximately 2:15pm Licensing Program Analysts (LPAs) Maja Jensen and Jennifer Fain arrived at facility unannounced to conduct a required one year annual visit. LPAs Jensen and Fain met with Administrator Grace Mata and explained the purpose of the visit. The Administrator holds current certificate # 6065133740 good through 12/20/2024. LPAs Jensen and Fain toured the facility The facility currently has 5 residents and provides dementia care. The grounds were observed to be well maintained and all paths were clear of debris. Two windows were observed to have torn screens and the dining room screen was determined to be missing. The facility was observed sanitary and free of odor. The carbon monoxide detector was tested and determined to be in good working order. The fire extinguisher was last serviced in December of 2022 and is in compliance. The first aid kit was determined to be complete with scissors, tweezers, thermometer and manual. The bathroom was observed to have grab bars at the toilet and shower. he bathtub was observed to have a non-slip mat. There are night lights set up in the hallway leading to the residents bathroom. The water temperature in the bathroom was measured at 119.5 degrees which falls within the required regulatory range of 105-120 degrees. The thermostat was set at 71 degrees for the comfort of the residents. The facility maintains a sufficient supply of linen. The facility maintains a 2 day supply of perishable food and a 7 day supply of non-perishable food. There was fresh fruit and vegetables available for residents in care. The facility caters meal service to each resident's preference. All knives, toxins and chemicals were observed to be locked and inaccessible to residents in care. Continued on LIC 809C.... The facility emergency disaster plan was reviewed and is in compliance. The facility conducts fire drills monthly. LPA Jensen reviewed 5 of 5 resident files. 2 of 5 resident admission agreements state that at least 30 days notice will be given for general rate increases. 3 of 5 resident admission agreements state that at least 10 days notice will be provided for a general rate increase which contradicts regulatory requirements in the Health and Safety Code §1569.655 (a) . 4 out of 5 resident admission agreements state that no refunds shall provided upon the death of a resident which contradicts regulatory requirements in the Health and Safety Code §1569.652 (c). . LPA Jensen determined that annual licensing fees have been delinquent since 2019. LPA Jensen requested a copy of the liability insurance and an updated LIC 500 be emailed to maja.jensen@dss.ca.gov by 3/27/23. Deficiencies are being cited from the Health and Safety Code (HSC). Failure to correct deficiencies may result in the assessment of civil penalties. An exit interview was conducted and a copy of this report and appeal rights were provided.