Routine inspection·September 18, 2023

On 9/18/23 LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Caregiver Jonathan Mendoza. LPA explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, common areas, kitchen area & garage. The indoor and outdoor passageways were free of obstruction. At around 11:30 am, the residents were observed to have lunch in dining area.. While touring the facility it was observed that the room temperature was at 71 deg F. Hot water was also tested in the bathrooms and the temperature was 108 deg F. Carbon monoxide monitor are working properly. All fire extinguishers have been checked and current. Resident bedrooms and bathrooms were observed to be in good repair equipped with grab bars and non-skid mats. All personal belongings of residents are intact. LPA checked the food supply and there is adequate amount of food, 2 days for perishables and & 7 days non-perishable. Emergency drills are logged and done every quarter. Two resident records and two staff records were reviewed. Staff records are complete, with training logs. Facility accepts hospice residents and are in compliance with the required waiver requirements. LPA interviewed two residents and one staff member. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. LPA requested the following documents: Control of Property, Certificate of Liability Insurance, LIC 500. Upon reviewing resident records it was found out that an incident wasn't reported to CCLD. A resident (R1) was sent to ER and no incident report was done or sent to CCLD. A deficiency was cited per California Code of Regulations, Title 22. See LIC809-D. A civil penalty is being assessed for the amount of $250 for repeat violation regarding reporting requirements. Please see LIC421FC. This report was reviewed with and a copy of the report and appeal rights was provided.