Routine inspection·May 1, 2024

On 5/1/24, Licensing Program Analyst (LPA) Tung Truong arrived unannounced to conduct a Required - 1 Year visit. LPA met with Administrator Grace Dulay and explained the purpose of the visit. Administrator holds current certification #6012122740 and expires on 3/21/24. Renewal application is currently pending. The facility is licensed to serve four residents ages 60 and above. Two may be non-ambulatory. Hospice approved for two (2) residents. There are 4 residents in care currently. LPA toured the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms; resident bathrooms, laundry area, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The hot water temperature was measured at 119.3*F which was within the required range of 105-120*F. The temperature inside the facility was observed at 72*F which was within the required range of 68-85*F. LPA observed the centrally stored medications area to be locked and inaccessible to residents. LPA observed the fire extinguisher(s) and first aid kits were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. Report continued on 809-C LPA requested resident and staff files for review. LPA reviewed two (2) staff files and four (4) resident files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. The following forms and documents were requested: LIC 308 Designation of Administrative Responsibility, LIC 500 Personnel Report, LIC 610 Emergency Disaster Plan and Proof of Current Liability Insurance. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed. Exit interview was conducted, and a copy of this report was left at the facility.