Routine inspection·December 29, 2023

Licensing Program Analysts (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPA Rodgers was granted entry into the facility by Director of Assisted Living Perla Provencal, after identifying herself and stating the purpose of the inspection. This facility serves one hundred and Seventy Seven (177) non- ambulatory elderly residents 60 and above; thirty (30) of whom may be bedridden. Hospice waiver approved for 24. A tour of the facility was conducted which included a sample of resident units, the dining area, recreation rooms, and food storage areas. There is a three-story complex with memory care on the first and second floor. PPE supplies are onsite. Passageways were free from obstructions. Facility does feature a locked perimeter on the first and second floor . Each resident had clean and sufficient bed linens. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. Hot water temperature in residents’ bathrooms were compliant. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC 809-C] Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Food supply is replenished frequently by outside vendors. Food was observed to be properly stored and labeled. The food service area was observed to be neat and clean. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked closed room not assessable to residents. Centrally stored medications were properly stored and locked in cabinets. Medication logs and medications reviewed were current and medications appear to be administered according to the label instructions. Resident records were reviewed and confirmed compliant. Administrator’s certification is current. LPA reviewed the theft and loss policy and procedures and made recommendations. LPA conducted a review of In-service training procedures. Transportation procedures are compliant. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. Based on LPA observation of resident’s rooms, licensee did not provide non- skid mats or strips in some room showers, which posed a potential health and personal rights risk to persons in care. A technical violation was also issued at today’s visit. Deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). A Plan of Correction was jointly developed with Director David Armour and Director of Assisted Living Perla Provencal. An exit interview was conducted with Director of Assisted Living Provencal to whom copies of this report, the LIC 809-D page, the LIC 9102TV, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of this visit..