Routine inspection·August 9, 2023

Unannounced annual licensing visit made out to this facility on 08/09/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Knicole Carbonell, who was briefly interviewed. This LPA requested that the facility caregiver go ahead and contact the facility designated Administrator, Joy Laja, to inform her that CCL was present at this time. The facility designated Administrator, Joy Laja, arrived thereafter to this facility. A brief interview was conducted with the facility designated Administrator at this time. This facility is licensed to serve and accept up to 15 residents who are deemed to be ambulatory and non ambulatory. This facility is not vendorized to accept and retain any Regional Center residents at this time. Current census was 8 residents. It was learned that there was (1) resident currently on hospice. There were (3) dementia diagnosed residents and (6) residents with bowel/bladder incontinence. Tour of this facility was conducted. Kitchen area was toured. Cabinets and drawers were reviewed. Drawers and cabinets housing cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Drawers containing knives and other cutlery were observed to be locked and made inaccessible to the residents at this time. Food supply was reviewed for 2-day perishable and 7-day nonperishable food quantities at this time. Additional nonperishable food items were observed to be stored in the garage area along with additional refrigerator and freezer units. Dining room, living area, and all other areas designated for resident use were observed to be maintained and observed to be in compliance at this time. A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be present and maintained in compliance at this time. A tour of the resident restrooms was conducted. Shower areas, toilets, and wash basins were reviewed and observed to be functional and in good repair at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Medication for resident use, located in kitchen cart, was reviewed. Policies and procedures for dispensing, handling, and overall documentation of the resident medications were discussed with the facility designated Administrator at this time. Fire extinguishers (3) were observed to be placed in the kitchen, dining, and laundry areas were annually inspected on 03/15/2023 from the local fire extinguisher company, Nor Cal Fire Inc, and in compliance at this time. First aid kit was observed to be present and contained all of the required components at this time. Linen closet, located in facility hallway, was observed to contain a sufficient supply of blankets, sheets, and towels for resident use. Laundry area, located adjacent to kitchen area, was observed to be made inaccessible to the residents at this time. Laundry detergents, bleach, and all other cleaning supplies were observed to be stored in cabinets where they were locked and made inaccessible to the residents at this time. Exterior grounds of this facility was toured. Facility perimeter fence, side gates, and emergency exits were reviewed. Additional garage space was reviewed and observed to be contain materials and items intended for upkeep and maintenance of this facility. A review of (4) facility personnel files was conducted. A review of (5) facility resident files was conducted. The following forms were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interview