Routine inspection·July 14, 2023

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 7/14/23 at 8:30am. Administrator Certificate expires 10/24/24 for Nai Saeteurn. License fees are current. LPA met with Kathy Aldrich, House Manager and Nai Saeteurn and discussed the purpose of the visit. The facility is licensed for a capacity of 6 non-ambulatory residents. Facility has hospice waiver for 4. There is 0 resident receiving hospice services at this time. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 75*F which is within the required range of 68-85*F. The hot water temperature was observed on the water heater to be measured at 120.0*F which is within the required range of 105-120*F. LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA reviewed 2 resident and 2 staff files and conducted interviews during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Facility Responsibility (LIC308) Personnel Report (LIC500) Administrator Certificate-Updated Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, copy of report given