Routine inspection·October 19, 2023

Licensing Program Analyst (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection visit to ensure substantial compliance with tittle 22 regulations. LPA Rodgers was granted entry into the facility by care giver, Elsa Tovar after identifying herself and stating the purpose of the inspection. The facility has one building with 2 different living areas. The facility is licensed for fifteen non-ambulatory elderly residents, seven of whom may be bedridden. There is an approved hospice waiver for fifteen (15). Seven (7) residents are currently on hospice care. LPA, accompanied by manager Elsa Tower, 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. Resident rooms contain required furnishings. There is an outdoor front yard with water feature. Smoke and carbon monoxide alarms are operable in the small building (consisting of 3 client rooms) and the large building (7 client rooms) have an operable signal system . 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 resident activities. Hot water temperature at taps accessible to residents were all compliant . Continued on 809-C Continued on 809-C There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients According manger Tovar, there are no weapons and/or ammunition stored on the premises. Each toilet and shared shower have grab bars for resident use and non-skid surfacing along with shower chair. Each resident room has sufficient lighting. Medications were labeled, as required, and stored in locked areas. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. Staff records review and verified that 6 of 6 staff do not have a current First Aid/CPR, TB clearance or Health Screening Report. They do have all required training. Resident records reviewed for a current Physician's Report, Resident Appraisal, Needs & Services Plan, Identification and Emergency Information and Admission Agreement. Administrator’s certification for David Cooper expires on December 1, 2024. A deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). The Department determined that the violation resulted in a potential safety hazard to clients. A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Licensee Cooper to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.