Routine inspection·April 3, 2024

Licensing Program Analyst (LPA) Ruth Wallace conducted a unannounced Required 1 year Inspection Visit. LPA met with direct care staff and explained the purpose of visit. Administrator's Certificate expires 12/18/2024. LPA and direct care staff inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, and outside backyard. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA measured the hot water temperature in resident's bathroom at 111.9 degrees Fahrenheit which is within the required range of 105 to 120 degrees. First aid kit was checked and is complete. LPA observed carbon monoxide detectors in the facility. Fire extinguishers were last inspected on 7/24/2023. Smoke detectors are operational. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. medication logs. LPA observed carbon monoxide detectors in the facility. The facility conducts fire/disaster drills with residents on 3/25/2024. Staff have been sleeping on a roll away bed in common areas which is not on fire clearance. Facility sketch shows bedroom #3 as staff room, but a resident in presently in #3 bedroom. 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 individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. LPA requested the following updated documents for community care licensing to be submitted via email by April 8, 2024: Facility Sketch, Fire Clearance, LIC 308 Designation of Administrator, LIC 500 - Personnel Report, Copy of Administrator's Certificate, and Copy of Liability Insurance. ruth.wallace@dss.ca.gov Based on today’s visit, Per California Code of Regulations, Title 22 Division 6, Chapter 8, see 809-D's for deficiencies observed or cited today. If the deficiencies are not corrected by the noted due date civil penalties may be assessed. Exit interview conducted with administrator. A copy of report and LIC 811 (Confidential Names) left at facility.