Routine inspection·June 17, 2024

LPA Audrey Jeung toured facility and grounds, consisting of 11 client bedrooms, 3 of which are shared--all with full private bathrooms. All but 3 rooms have direct access to enclosed paved patio. No accessible bodies of water or fire safety hazards observed. PPE supply is adequate and first aid kit is complete. Perishable and non-perishable food supply is maintained. Infection control signs are prominently posted. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable temperature is maintained, and lighting is sufficient for comfort and safety. Hot water temperature is tested at 120 degrees in public bathroom. Toilet and bathing facilities are equipped with grab bars and nonskid flooring material. Liquid soap is available at all sinks. An updated Disaster and Mass Casualty Plan is accessible to staff. There are 13 residents present, and 2 caregivers. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Linda Ishii-Chan is a certified RCFE administrator that oversees facility operations. Staff and client files are reviewed. The following updated forms/information are requested to be submitted to CCLD BY 7/1/24: • LIC 309 Administrative Organization • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report The following information is provided to LPA: • Proof of current Liability Insurance • Page 9 of Emergency Disaster Plan (LIC610E) Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on a following page. See also 2 Technical Advisiory Notes.