Routine inspection·July 21, 2023

Licensing Program Analyst (LPA) Cheryl Goodrich conducted an unannounced annual visit. LPA met with the Administrator Aleksandar Boskoski at the front door and was granted entry. The purpose of today’s visit is to inspect the facility to ensure that the facility follows California Code of Regulations, Title 22, Division 6. Facility is approved for six (6) non-ambulatory residents of which one (1) may be bedridden in room # 3 and Hospice Waiver for # 4. Facility has two (2) residents 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 74 degrees; residents' main restroom water temperature read at 118.3 degrees; there were no bodies of water on premises. There are 6 bedrooms and three bathrooms for the residents. There is one bedroom for staff. There was sufficient lighting and mattress pads in all the residents' bedrooms. The fire alarm and smoke carbon monoxide detectors were in working order. Facility does not house firearms and/or ammunition on grounds. 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. There is emergency food supply available for all residents and staff. 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. The Administrator has completed a written admission agreement, current medical assessment and needs and service plan with each resident. Waivers are in place and meet said terms. Administrator handles no resident cash resources. Administrator Certificates for both Aleksandar Boskoski and Dragana Lekovich is current and will expire on 09/04/2024. Items Discussed : The Administrator did not complete the fire drill for the second quarter, as evidenced by the fire drill log and by the Administrator’s admission. The facility has not been documenting the date and time PRN medications were given to the residents. Summary : Based on today's visit, one deficiency was given and a technical violation. An exit interview was conducted with Administrator Aleksandar Boskoski and a copy of this report was printed Signature below confirms receipt of these rights.