Post-licensing visit·July 3, 2023

On 07/03/2023 at approximately 12:30 pm, Licensing Program Analysts (LPA) Renee Campbell and Victoria Brown arrived unannounced to the facility to conduct a Post-Licensing visit and met with Maxima Martin, Administrator. LPA's stated the purpose of the visit. Facility has 5 residents. Licensee Maxima Martin has four staff members (in addition to herself) who work for the facility. LPA Campbell requested 2 of 4 staff files and 3 of 5 resident files for review. LPA's toured the facility physical plant to include the kitchen,living rooms, bathrooms, dining rooms and outside area. LPA's observed perishables to last two days and non-perishables to last 7 days. Knives and cleaning supplies were locked. All rooms were found to contain a bed, night table and lamp and were well lit for the comfort and safety of the residents. The thermostat was set at a comfortable temperature of 73 degrees Fahrenheit and water temperature was measured at 106 degrees Fahrenheit. The fire extinguisher was last inspected on 02/09/23. A first aid kit was found to be complete and medicines were separated by client names. The backyard area was observed to have a shaded seating area. No bodies of water were found. All staff had CPR/1st Aid Training. All indoor passageways were free of obstruction. All staff are associated to the facility. The following forms to be updated and submitted to CCL by 07/10/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate (cont) Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 809D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Administrator was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted and a copy of this report was provided.