Routine inspection·October 4, 2024

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by Assistant Administrator Richard Tibi. LPA discussed the purpose of the visit with Assistant Administrator Tibi. According to the facility’s license, there may be a maximum of 32 residents all of whom may be non-ambulatory in at any given time at the facility site. The facility is approved seven (7) hospice residents, and four (4) bedridden residents. They also have a waiver for non-physicians to prescribe medications. During today’s inspection, the facility’s current census is 24 residents living at the facility. There were 20 residents present at the facility site during the inspection. LPA, accompanied by Assistant Administrator Tibi, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 74 degrees Fahrenheit (F). Hot water temperature at taps accessible to clients were not all compliant: kitchen sink measured hot water at 115.2 degrees F; sink in restroom #1 delivered hot water at 116.4 degrees F; sink in restroom #2 delivered hot water at 116.4 degrees F; sink in restroom #3 delivered hot water at 116.2 degrees F; sink in restroom #4 delivered hot water at 116.4 degrees F; sink in restroom #5 delivered hot water at 115 degrees F; sink in restroom #6 delivered hot water at 113.9 degrees F; sink in restroom #7 delivered hot water at 126 degrees F; sink in restroom #8 delivered hot water at 127.8 degrees F; sink in restroom #9 delivered hot water at 125.8 degrees F; sink in restroom #10 delivered hot water at 124 degrees F; sink in restroom #11 delivered hot water at 123.4 degrees F; sink in restroom #12 delivered hot water at 125.8 degrees F; and sink in restroom #13 delivered hot water at 124.5 degrees F. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking, dining equipment and utensils were present, and all safely stored in a locked kitchen area. There were no toxic chemicals or poisons accessible to residents. Medications were properly labeled, as required, and stored in locked cart. LPA inspected the medication cart and confirmed medications were properly labeled and stored. No pools or bodies of water on the premises. Per Assistant Administrator Tibi, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers were present (05) and serviced within the last 12 months. First aid kit was complete and readily accessible. LPA reviewed staff and resident records. During today’s visit there were 20 residents on the facility premise. LPA's inspection did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility. Deficiencies observed and cited during today's annual inspection may be found on the LIC809-D page of this report. An exit interview was conducted with Assistant Administrator Richard Tibi to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received. LPA requested Assistant Administrator Tibi to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, Emergency Disaster Plan LIC 610-E, and Residential Infection Control Plan LIC 9282 (6/23), to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov .