Routine inspection·July 7, 2023

Licensing Program Analyst (LPA) Cheryl Goodrich conducted an unannounced annual visit. LPA met with the caregiver Elizabeth OLeary at the front door and was granted entry. Licensee Annie Allen arrived during the visit. The purpose of today’s visit is to inspect the facility to ensure that the facility is following California Code of Regulations, Title 22, Division 6. Facility is approved for six (6) non-ambulatory residents. Three (3) residents are on hospice. Physical Plant: front entrance, interior and surrounding exterior were clean and in good repair with no pathway obstruction; doorway alarms were in working order; facility temperature read at 73 degrees; residents' main restroom water temperature read at 102.8 degrees; there were no bodies of water on premises; there was sufficient lighting and mattress pads in all of the residents' bedrooms; fire alarm and smoke carbon monoxide detectors were in working order. Facility does not house firearms and/or ammunition on grounds. Cleaning supplies was stored outside in a locked shed. Food Services: 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available to residents. Medication/Facility Records: Medications were observed to be labeled and in a locked place that is inaccessible to residents. All staff subject to a criminal record review obtained fingerprint clearance and/or an exemption. Staff responsible for direct care and supervision have current First Aid / CPR training. Licensee has completed a written admission agreement, current medical assessment and needs and service plan with each resident. All required postings were posted throughout the facility, facility medication/PRN logs were reviewed and residents’ medications were inspected for dispensing according to physician’s orders. Exceptions & waivers are in place and meet said terms. Licensee handles no resident cash resources. Items reviewed/discussed : Staff member Aurora Flores is pending a fingerprint clearance. Facility, staff and residents’ records were reviewed. There is no fire evidence of fire drills being conducted at the facility. The Administrator stated they have not conducted fire drills since COVID. Administrator Certificate is current and will expire on 10/25/23 however the Administrator has not received a copy of her certificate from the agency. The Administrator was able to provide proof of courses taken and proof of mailed documents. Summary: Deficiencies are being cited per Title 22, Div. 6, Chap 8 and listed on LIC 809-D. An exit interview was conducted, Appeal Rights (LIC 9098 01/16) along with a copy of this report was provided to licensee Annie Allen and her signature on this form confirms receipt of these rights.