Routine inspection·July 24, 2024

On 07/23/2024, Licensing Program Analyst (LPA) Jaime Vado and conducted an unannounced annual inspection visit. LPA met with administrator Editha Muncada and explained the purpose of today's visit. LPA was allowed entry into the facility. This is a single level facility. All residents are approved to be non-amblatory and 2 hospice residents. There are 2 residents on hospice at this time. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen in a drawer adjacent to the facility stove. Medications a re observed to be locked in a kitchen cabinet. Perishable and non-perishable food items are observed as in place. Refrigerator is observed as having both lights out inside the freezer and main refrigerator. Additionally the lower refrigerator drawers and bins are broken or not in place leaving some fresh food supplies exposed and leftover food is not labeled with dates. This can pose a potential health and safety risk. Cleaning supplies are observed to be locked beneath kitchen sink. First aid kit is observed as complete with required items. LPA observed that there are multiple fire extinguishers in place last inspected 08/06/2021, smoke detectors, carbon monoxide detectors are observed in place through out the facility, facility is equipped with full fire sprinklers through out, and central heating system including and fans for facility use. PPE supplies and linen supplies are in place. Laundry area is also observed as fully operational in an exterior shed. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Facility does not have a record for conducting an emergency which can pose a potential health and safety. Water temperature was measured at 115F in a common bathroom in the hallway connecting to resident rooms. Continued on next page... Page 2 LPA observed resident rooms at random and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Client linen supplies are observed as in place. The following updated forms are requested to be submitted to CCLD by 07/31/2024 : • Copy of updated Administrator Certificates • LIC308 Designation of responsible staff person • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule • Copy of control of property or current lease Technical violations are issued and attached on the following LIC9102 pages. Report is reviewed with administrator Editha Muncada.