Routine inspection·January 4, 2023

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Annual Inspection Visit. LPA met with Administrator and explained the purpose of the visit. There are three (3) clients in the facility. LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. There are 4 client bedrooms and 2 client bathrooms. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. The hallway has COVID precautions in place including social distancing and other signage noted. Medications noted to be locked to residents in care. LPA also conducted the infection control domain tool. The hot water temperature was observed to be 115.4 degrees Fahrenheit, which is within the required regulation of 105 to 120 degrees Fahrenheit. Food supply is adequate for 2 day perishable and 7 day nonperishable. LPA observed knives and toxins to be locked away and inaccessible to clients. Smoke and carbon detectors were in good repair. Fire extinguisher was inspected on 7/20/2022 and first aid kit was up to date. LPA checked medication storage and found medication to be locked away and inaccessible to clients. The facility submitted a LIC 808 mitigation plan , which was approved. LPA reviewed two (2) staff records and two (2) client records. All files were complete. Staff are fingerprint cleared and first aid certified. LPA observed the medication and the MARS sheets. Medications appear to be documented appropriately. LPA requested the following documents to be submitted via email by January 11, 2023: Administrator Certificate, LIC 308 - Designation of Administrator Responsibility, LIC 610E, and LIC 500 Personnel Summary No deficiencies observed or cited on today's date. Exit interview conducted with administrator and a copy of this report was left at the facility.