Routine inspection·September 21, 2023

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Jo Ann Wright, Administrator (ADM). During visit, LPA Marrufo observed that ADM was preparing food in aluminum trays in the kitchen. ADM stated that ADM has a job today delivering catered food to a board meeting. ADM stated she is getting paid for the catered food. LPA Marrufo observed food trays, a baked cake that ADM stated she baked in the facility kitchen, a pot of gravy, and a propane-powered stove in the outside of the facility with a pot of heated oil. LPA Marrufo observed a tray of fish covered in flower that ADM stated she will cook in the outdoor stove. LPA Marrufo reviewed the resident records. LPA Marrufo observed that there were 2 medications without prescription labels and two bottles of medications that had the incorrect amount of pills based on the start date. LPA Marrufo observed resident R1's Appraisal/Needs and Services Plan was missing 2 out of 4 pages and was not signed by client or client's representative. R1's Safeguard for Property/Valuables is not the official LIC form and does not have client's signature/initials. LPA Marrufo toured the kitchen area and found 4 cans of expired food. LPA Marrufo observed 2 out of 2 bathrooms and observed the water temperature to be 125 F. LPA Marrufo tested the facility carbon monoxide detectors and smoke alarms. 2 out of 2 carbon monoxide detectors functioned properly when tested. 4 out of 7 smoke detectors functioned when tested but had a very faint alarm sound when tested. ADM stated during visit to have conducted an emergency disaster drill, but does not keep an emergency disaster drill log. See LIC809-C for more information. Page 1 of 2. LPA Marrufo observed 2 out of 2 bathrooms. Each bathroom had available soap, paper towels, and showers with chairs, hand railings, and mats. The water temperature measured at 115 F in 2 out of 2 bathrooms. Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D pages for more information. A civil penalty of $250 was issued for a repeated violation. An Advisory Note was issued. See LIC9102 for more information. This report was reviewed with ADM Jo Ann Wright and a copy of the report and appeal rights were provided. Page 2 of 2. END REPORT.