Routine inspection·January 31, 2023

On 1/31/23 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required one year annual visit. LPA Jensen met with Executive Director Brittany Andrews and explained the purpose of today's visit. The facility is a two story structure with a capacity to serve 86 resident and a current census of 77. The grounds were observed to be maintained and clear of obstruction and debris. There is pond on the premises that was observed to be gated and locked. There is sufficient outdoor furniture for the residents to participate in outdoor activities and pergolas for shade. The interior of the facility was toured including common areas, dining room, kitchen, life enrichment room, guest reception areas, resident apartments, laundry room and medication room. The facility was observed to be sanitary and free of odor. LPA Jensen observed and tested carbon monoxide detectors and determined them to be in good working order. LPA Jensen observed the fire extinguishers were last serviced in November of 2022 and are in compliance. The Ansul System was observed to be last serviced in November of 2022 and is in compliance. LPA Jensen observed the facility to maintain a first aid kit that was complete with scissors, tweezers, a thermometer, various wound dressings and 1st aid manual. The facility has stair wells that are quipped with evacuation chairs. The temperature in the common areas of the facility was observed to be set 72 degrees which falls within the required regulatory range of 68-85 degrees. The facility is currently undergoing window replacement on the upper level. An upper level window in the main hall was removed this morning and is being replaced with an expected completion same day. The work area was sectioned off with caution tape. Continued on LIC 809C.... The resident bedrooms were observed to be adequately furnished and contained dressers, night stands, lamps. The temperature in resident apartments was measured at 120 degrees which falls within the required regulatory range of 105-120 degrees. The Medication Administration Records are electronic and PRN effectiveness is documented. The medication room is locked and inaccessible to residents in care. The narcotics were observed to be double locked. LPA Jensen verified the narcotic count with Medication Technician 1 (MT1) and determined the record keeping to be accurate. 3 resident files were reviewed. 3 of 3 resident files lacked an LIC 621. The resident file for resident 1 (R1) also lacked a current resident evaluation. The resident evaluation for R1 was last conducted on 3/17/21. 2 of 3 resident files reviewed have physician orders to retain and manage their own medication. The kitchen was observed to have in excess of 2 days of perishable food and 7 days of non-perishable food. The menu was posted outside of the dining hall and is also delivered to individual suites. The menu accurately reflected was observed to be served during lunch service. LPA Jensen requested a current LIC 500 and a current copy of liability insurance be emailed to maja.jensen@dss.ca.gov by 2/2/23. Deficiencies are being cited on this day from the California Code of Regulations (CCR) Title 22, Division 6. Failure to correct deficiencies may result in the assessment of civil penalties. An exit interview was conducted and a copy of this report and appeal rights were provided.