Routine inspection·January 26, 2022

Licensing Program Analysts (LPA's) Ruth Wallace and Maja Jensen conducted an unannounced annual/random inspection on 1/26/2022. LPA's met with Administrator Maria Brelin and explained the purpose of the visit. Administrator Certificate #6041889740 expires 07/17/2022. This facility is a single story building licensed to serve six (6) non-ambulatory residents of which 1 resident may be bed ridden and a hospice waiver for 6 residents. LPA's toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA's observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed a body of water at the facility to be unlocked and unsecured with a gated fence around the pool. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at (115.2) degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguishers expire 01/20/2023. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to residents. LPA reviewed staff associations to the facility. First aid kit was checked and is complete. Deficiency is cited from California Code of regulations, Title 22, Division 6, 8 and citation is listed on the attached LIC 809-D. Immediate Civil Penalty Assessed of $500.00. Exit interview held with Maria Brelin. A copy of reports, civil penalty, and appeal rights left with Administrator.