Routine inspection·January 17, 2024

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced Required 1 Year Inspection Visit. LPA met with administrator and explained the purpose of the visit. Administrator certificate #6003830740 expires on 7/7/2025. This facility is a single story building licensed to serve six (6) non-ambulatory residents and a hospice waiver for two residents. LPA and administrator toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 113.6 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers serviced 1/12/2024. Smoke and carbon monoxide detectors are in compliance with fire safety. Fire drill last conducted on 10/22/2023. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed three resident and three staff files, including criminal record clearances. LPA reviewed Fingerprint clearance and associations to the facility. First aid kit was checked and is complete. LPA requested the following forms to be submitted via email by February 6, 2024: LIC 308, Liability insurance Certificate, and Administrator Certificate. ruth.wallace@dss.ca.gov No deficiencies cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Exit interview held with Administrator. A copy of report and LIC 811(Confidential Names) given at the conclusion of the visit.