Routine inspection·November 28, 2022

Unannounced annual visit made out to this facility on 11/28/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Yashmin Ubaldo, who was briefly interviewed at this time. This facility is additionally vendorized through Valley Mountain Regional Center to accept and retain up to (4) residents at Level 4I. Current census was (2) residents. Tour of this facility was conducted. Living room, dining room, and all other areas designated for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Kitchen area was toured. Cabinets and drawers containing items and materials for use by the residents were reviewed. Storage spaces housing knives and chemicals were observed to be locked and made inaccessible to the residents at this time. Food supply for 2-day perishable and 7-day nonperishable quantities were observed to be present and able to meet the needs of the residents at this time. Medication cabinet, located in the kitchen area, was observed to be locked and made inaccessible to the residents at this time. Policies and procedures for handling, dispensing, and documenting of all resident medications were discussed with the facility designated Administrator at this time. First aid kit was observed to be present and did contain all of the required components at this time. A tour of the resident bedrooms was conducted. Bedroom furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the resident restrooms was conducted. Grab bars and non skid mats/surfaces were observed to present and in functional order at this time. Linen closet was observed to be present in a resident restroom and did contain all of the necessary towels and wash cloths to meet the needs of the residents. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees at all times. Laundry area was toured. It was learned that all laundry detergent, bleach, and cleaning agents were stored in the garage area at this time. Garage area was toured. All cleaning agents, supplies, and laundry chemicals were observed to be locked and made inaccessible to the residents at this time. Additional nonperishable food supplies were observed to be present in the garage area at this time. Fire extinguishers were observed to be present and placed throughout this facility. They were observed to have been annually inspected by the local fire extinguisher company, Armor Fire Extinguisher Company, on 07/12/2022 and in compliance at this time. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gate, and exits was conducted. The following forms and documents were requested by this LPA to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interview