Routine inspection·February 13, 2024

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection visit. LPA met with the administrator and explained the purpose of the visit. Administrator certificate expires 6/4/24. LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility has four bedrooms and two bathrooms. There is a formal living room available for residents and a dining room off the kitchen . Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Common touch surfaces are cleaned after each use. LPA measured the hot water temperature in resident's bathroom at 111.2 degrees Fahrenheit which is within the required range of 105 to 120 degrees. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was last inspected 11/17/23. Facility has an emergency food and water kit. LPA reviewed four resident files and four staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. Staff #1 and #4 did not have current first aid certificates. LPA requested the following updated documents via email to community care licensing by February 16, 2024: LIC 308 Designation of Administrator, LIC 500 Personnel Report, Copy of Administrator's Certificate, and Copy of Liability Insurance. ruth.wallace@dss.ca.gov Per the California Code of Regulations, Title 22, Division 6, Chapter 6, see 809-D for deficiency cited during this visit. Exit interview was held with Administrator. A report and LIC 811(Confidential Names) was left at facility.