Routine inspection·January 19, 2022

Licensing Program Analyst (LPA) Ruth Wallace arrived unannounced to conduct a Required Annual/Random Inspection at 9:10 am and met with Office Administrator Karen Snodgrass. LPA COVID screened upon entry to the facility. LPA was allowed entry into the facility that is licensed to serve a total capacity of 14 residents. Today's census is 11 of which 1 is Hospice. Five of five staff observed on site with criminal record clearance in Licensing Information System. LPA observed Administrator Certificate (Zachary Murphy) expires on 9/26/2022. LPA toured physical plant with Office Administrator inside and outside to ensure the safety of the residents. LPA observed two facilities on two properties housing residents. LPA observed kitchen, garage, restrooms, bedrooms, and common living areas to be clean and in good repair. LPA observed five of eight resident rooms without required furnishings including chair, chest of drawers, and night stands. S2 stated they have just purchased some night stands. The temperature inside the facility was measured at 75*F which is within the required range of 68*F and 85*F, or in areas of extreme heat the maximum shall be 30*F less than the outside temperature. The hot water was measured at 107.3*F and 110.5*F within regulatory range of is not less than 105*F and not more than 120*F. LPA observed the centrally stored medications, toxins, and knives stored in the locked garage office to be locked inaccessible to residents. The first aid kit was found in compliance containing at least the following: a current edition of an approved first aid manual, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. LPA observed fire extinguishers, smoke and carbon monoxide detectors, central heating and air in the facility. LPA observed food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times. LPA observed COVID precautions signs posted, restrooms stocked with paper towels, hand soap and touchless covered trash cans, no hand washing signs observed. Licensee stated he would put them up at sinks. Licensee stated 30 day supply of PPE stored is stored on site in his garage at home. LPA observed bacterial analysis of private water supply is being conducted annually and logged by a maintenance person. Licensee stated all residents and staff are drinking water from water bottles at this time. The facility has an approved Mitigation Plan. Upon a file review the following items were discussed to be submitted to LPA by 01/27/2022: Designation of Administrative Responsibility LIC308 Personnel Report LIC500 Copy of Bacteriological Analysis of Private Water Supply Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are during this visit. Exit interview held and a copy of report was given.