Routine inspection·November 1, 2019

Licensing Program Analyst (LPA) Denise Powell conducted an unannounced Required One Year visit to ensure substantial compliance with Title 22 regulations. The facility is licensed for sixty-four elderly residents, all of whom may be non-ambulatory with an approved hospice waiver for fifteen residents (waiver increase approved, confirmation letter pending). Bedridden fire clearance is currently approved for ten residents. There are fifteen residents currently on hospice care. LPA was granted entry and met with Cindy Niedrich Resident Services Director (RSD), then conducted a tour of the facility, inside and outside. The facility appeared clean and in good repair, with comfortable and attractive accommodations provided. LPA observed food service and group activity and saw residents in care being treated with dignity by staff. Adequate caregivers were on duty to meet residents needs. All indoor and outdoor passageways were free from obstruction. The facility is operating in accordance to their fire clearance. Carbon monoxide and smoke detectors are hard wired and operable. A comfortable temperature of 74 degrees was maintained. Hot water temperature in resident bathrooms was measured at 114.9 degrees F. Each toilet and shower has grab bars for resident use and non-skid surfacing. Resident rooms have sufficient lighting. Food supplies were appropriately covered and labeled and menus were on hand. Medication is centrally stored and secured in locked medication rooms located on each floor. Staff records were reviewed and indicated current first aid/CPR training along with other required training. Review of a sample of resident records indicates that in each file, there is a current medical assessment, needs and services plan, appraisal and a signed, dated Admission Agreement. Minor deficiencies were observed in areas inspected during today's visit and are noted on the attached 809-D form. LPA provided additional guidance on emergency disaster planning, designated smoking area and advertising requirements. Administrator will submit updated LIC500 and LIC610E forms within ten days. An exit interview was conducted, plans of correction were reviewed and a copy of this report along with licensee rights was provided to RSD Cindy Niedrich whose signature below confirms receipt of these rights. THIS IS AN AMENDED REPORT, dated 10/11/21. The Type B deficiency for 87468.2 (Personal Rights) as noted on 809-D form has been dismissed upon appeal.