Routine inspection·December 18, 2023

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Lora Statler, House Manager and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (15) and a current census of (9) residents in care. The facility has a hospice waiver for (6) residents. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant: Indoor and outdoor passageways are free of obstruction. The facility has no bodies of water accessible to residents in care. Outdoor area is fenced and sufficient for resident activities. The facility has sufficient lighting and is maintained at a comfortable temperature. Resident’s bathrooms were operating in safe and sanitary conditions. The hot water temperature in residents' bathrooms measured between 105 to 112 degrees F. Resident’s bedrooms have sufficient lighting and furniture in good repair. Facility has operating carbon monoxide alarms and telephone service. The facility has sufficient linen, towels, and personal hygiene items for residents. The facility has posted: facility license, Ombudsman poster, "Oxygen in use" signs, disaster evacuation plan and emergency telephone numbers. Food Service: Facility has sufficient non-perishable and perishable food supply for residents in care. The refrigerators and freezers are operating in a healthful manner. Sharps, pesticides and other cleaning solutions were kept locked and stored away from food areas. Care & Supervision : Facility has 24-hour/7 days a week care staff. Record Review: The last emergency drill was conducted on 12/13/23. Administrator’s certification expires on 4/14/2024. LPA review of staff files reveal, the facility did not maintain record of CPR training for staff #2 (S2), staff #3 (S3), and staff#4 (S4). The facility did not maintain a criminal background clearance and health screening for staff#1(S1). LPA review of resident files reveal, resident #1 (R1) had an incomplete residential appraisal on file. LPA facility record review reveals, the facility did not maintain record of liability insurance. Medical Related Services : All medication is centrally stored and kept locked. Based on LPA observations and record review, deficiencies and civil penalties are being cited per Title 22, Division 6 of The California Code of Regulations. An exit interview was conducted where reports (LIC809/LIC809-D/LIC9102) were discussed and copies with Appeal Rights were provided to the House Manager at the conclusion of the visit.