Routine inspection·January 11, 2023

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced Required 1 Year Annual Inspection Visit. LPA met with Administrator and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 10 residents of which 4 may be ambulatory, 6 non-ambulatory, and 1 bedridden. LPA and administrator 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. There are no bodies of water observed. A comfortable temperature is maintained at 74 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 107.3 degrees Fahrenheit which is within the required regulation of 105 to 120 degrees Fahrenheit. There is a minimum of 7 day supply of nonperishable and 2 day of perishable foods. LPA observed smoke detector is interconnected with the fire department. Carbon monoxide was in operating condition during inspection. Fire extinguisher was last serviced on 11/3/2022. First aid kit was observed to be complete. Fire drill was last conducted on 12/28/22. LPA observed completed mitigation plan. LPA reviewed two (2) resident files and two (2) staff files. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to residents. LPA reviewed resident and staff roster. LPA reviewed staff associations to the facility. LPA requested the following forms to be submitted via email by February 6, 2023: LIC 308, LIC 610-E, Liability insurance Certificate, and Administrator Certificate. No deficiencies cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Exit interview held with Administrator and a copy of report given at the conclusion of the visit.