Routine inspection·June 17, 2021

On 06/17/2021 at 8:25am, Licensing Program Analyst (LPA) T. White spoke with Facility Manager, Joyce Martin regarding facility risk assessment questions. Facility Manager confirmed no staff or clients have experienced symptoms within the last 10 days. At 9:20am, LPA T. White arrived unannounced to conduct a required 1-year annual inspection. LPA met with Licensee and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 15 residents, which one may be non-ambulatory. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 79 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 109.2 degrees Fahrenheit. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during inspection. Fire extinguisher was last serviced on May 27, 2021. First aid kit was observed to be complete. LPA observed approved mitigation plan. - LPA observed a hole in the facility hallway. - LPA observed a cracked floor in residents shared bedroom. - LPA observed broken fan hanging from ceiling in residents bedroom. - LPA observed hammer in kitchen accessible to clients. Report continues on 809C. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 06/25/2021: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610 Emergency Disaster Plan The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. Exit interview conducted with Administrator. A copy of report and Appeals rights given.