Routine inspection·June 23, 2023

Licensing Program Analyst (LPA) Grace Donato made an unannounced annual visit to the facility. LPA met with caregiver Josephine Manzano. LPA explained the purpose of the visit. LPA toured the facility inside and outside including resident rooms, common areas, garage & bathrooms. The indoor and outdoor passageways were free of obstruction. The residents have adequate amount of linens in their bedrooms. All personal belongings are intact. While touring the facility it was observed that the room temperature was at 75 deg F. Resident bedrooms and bathrooms were observed to be in good repair. Bathrooms are equipped with grab bars and non-skid floors and mats. Carbon monoxide monitor are working properly. All fire extinguishers have been checked and current. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Sharps and chemicals are locked and inaccessible to residents. Emergency drill has only been done once a year. Hot water was also tested in the bathrooms and the temperature was 140 deg F. It was corrected by facility staff right away. Temperature went down to 120 deg F. Per facility sketch, Room No. 5 was used as a staff room instead of a resident room. It was observed that there is a double decker bed at the garage. Facility staff is going to remove and dispose of it by 06/30/2023. Two resident records and four staff records were reviewed. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirements. 1 out of 4 staff member is currently taking trainings that are required. Facility has a certified administrator with complete certification and training requirements. Facility accepts hospice residents and are in compliance with the required waiver requirements. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. LPA interviewed 2 residents and 2 staff members. LPA requested to submit the following and was received in the facility at 6/23/2023: LIC 308 Designation of Facility Responsibility Administrator Certificate LIC 500 Personnel Report Liability Insurance To be emailed to LPA or faxed by 6/30/2023: Control of Property The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. A technical violation was given. Report is reviewed and a copy is provided.