Routine inspection·April 3, 2024

Unannounced annual visit made out to this facility on 04/03/2024 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility staff persons, Jenilyn Tabaco and Diana Reitz, who were briefly interviewed. This LPA later met another facility staff person, Well Tabaco, while conducting this annual visit. This LPA requested that the facility staff go ahead and contact the facility designated Administrator, Rick Reed, to inform him that CCL was present at this time. Current census was 14 residents. It was learned that there were not any residents under the care of hospice at this time. It was learned that there were not any residents receiving services through home health at this time. It was learned that there were (2) residents diagnosed with dementia at this time. The facility designated Administrator, Rick Reed, arrived later to this facility while this LPA was conducting this annual visit. Facility staff files were supplied by the facility designated Administrator. This LPA requested for (4) facility staff files at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Additional food storage units were observed to be present and functional at this time. Laundry area was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Administrator certificate, #6003307740, for Rick Reed was observed to have an expiration date of 07/08/2025 and in compliance at this time. Medication cabinet, located in the facility dining area, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located on kitchen door, was reviewed. This LPA observed that it did contain all of the required components at this time. Fire extinguishers, located throughout this facility, were observed to have been annually inspected by the local fire extinguisher company, Butch Young, on 03/27/2024 and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. This LPA observed additional storage sheds that were present on the south side and north side of this facility at this time. These storage sheds were observed to be locked and made inaccessible to the residents at this time. A review of (5) facility resident files was conducted and noted on the following LIC 858. A review of (4) facility staff files was conducted and noted on the following LIC 859. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interview