Routine inspection·October 7, 2024

At 11:40am on 10/07/2023, Licensing Program Analyst (LPA) Jeffries arrived at the facility to conduct and unannounced annual inspection visit. LPA met with Administrator Dimfna Koc de Jong announced who he is and the reason for the visit. The facility consists of a two-story house on a large property. The first level of the house consists of a dining room, sitting room, office, warming/staff kitchenette, a family room, 5 resident bedrooms and 2 bathrooms. The second level of the house consists of the living room, family room, dining room, main kitchen, laundry room, 4 bedrooms and 2 bathrooms. There is a deck off of the upstairs dining room and a ramp leads outside to the first floor. The facility has a swimming pool and spa that are gated and locked per regulation requirements. There are several outdoor areas with appropriate furniture and shade available. LPA toured facility with Administrator. LPA noted concerns with facility floor having several areas where the floor is causing spacing between the tile, which the facility is addressing as needed. LPA also noted that a closet on the top floor has evidence of water leakage. Based on the water leakage and the repairs that were addressed of the facility floor LPA will issue a citation of, 87303(a) for the facility to be in good repair at all times and request that Administrator have a structural engineer assess the integrity of the facilities structure in a timely manner. The facility is maintained in conformance with state fire marshal regulations. Smoke detectors and carbon monoxide detectors functioning throughout the facility. There is a sprinkler system in the ceiling of facility that was last pressure tested by Mid Coast Fire on 07/16/2024, billed to Dave Clark of Atascadero Mutual Water Company. Fire extinguishers were fully charged. Inside and outside passageways are free from obstruction. The facility temperature was 72 degrees F. Hot water temperature tested and within regulation parameters. Residents’ rooms are appropriately furnished with adequate lighting. LPA observed more than two days of perishable and more than seven days of non-perishable food. Food is stored in proper containers in the refrigerators and freezers. LPA reviewed Emergency Disaster Plan, Infection Control Plan, staff and resident files, training records and centrally stored medication records. LPA noted that facility last conducted and documented an emergency evacuation dill on May 8 th , 2024, which is past due on the quarterly requirements required by regulations (1569.695(c)), citation issued. CONTINUED on LIC9099-C Licensee and LPA conducted a full review of the annual control tools. LPA noted no other violations or citations issued aside from the two mentioned above. Exit interview, report read, appeal rights, and report provided.