Routine inspection·September 1, 2023

Licensing Program Analysts (LPAs) Darlene Chavez and Kristin Kontilis conducted an unannounced required Annual Inspection at the facility. The facility is a one-story home which is licensed as a Residential Care Facility for the Elderly (RCFE) with a dementia diagnosis. The facility has been approved for a hospice waiver for 4 residents and has a fire clearance for 6 non-ambulatory residents, one of which can be a bedridden resident. Upon arrival, there were six residents in care and two staff on duty. Currently there are six residents residing in the facility with 1 resident on hospice. Administrator Timothy Pryko arrived at approximately 9:59 am. LPAs explained the purpose of the visit. Entrance interview conducted. A tour of the physical environment and accommodations were assessed. The following was noted: LPA observed the required posting of the complaint poster, bill of rights and Resident’s Rights. LPA inspected the facility for fire safety, personal accommodations, and food service. First aid kit was observed to be complete. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors, and floor coverings were checked. The facility was seen to be in good repair inside and outside. There is one fire extinguisher located in the common area, last serviced on 1/15/2023. The carbon monoxide alarm and smoke alarms are in good working order. Medications are kept in a locked centrally stored cabinet. The kitchen, living room and dining area are neat and clean. The facility maintains a comfortable temperature. Hallways, bedroom doors and walls are in good repair. The kitchen has a refrigerator, dishwasher, toaster, hot water teapot, and a stove-top oven. LPAs observed the kitchen stove has knobs in place and is accessible to residents in care. Between 10:15 am and 11:09 am, the refrigerator located in the kitchen was measured at 43.1 degrees Fahrenheit (F) and the freezer was measured at 5.8 degrees F. The refrigerator located in the hallway closet was measured at 35 degrees (F) and the freezer was measured at 17.3 degrees (F). Please continue to 809-C, Pg 2. The facility has 5 private bedrooms with private baths. Bedroom #1 is a private bedroom with access to the bathroom across the hallway. Each resident’s room is furnished with overhead lights to provide sufficient lighting, a nightstand, and a bed. The laundry area and storage area are located off the hallway. Cleaning agents and detergents are kept locked and inaccessible to residents in care. The backyard consists of a covered and fenced patio area with chairs and tables. The patio has planters, walkways, and built-in garden areas. The trash, recycling, and green waste cans are standardized cans located outside the facility. There is a hard-wired dual carbon monoxide detector and smoke alarm system in every room and each hallway. LPAs observed a comfortable room temperature throughout the facility. Residents participate in activities based on their individual interests and preferences, including musical entertainment, painting, drawing, social activities, and puzzles. Outdoor activities include socializing, leisure walks, visitors from community organizations, and seasonal celebrations. Residents records were reviewed and were found to be current and in good order. Staff records were reviewed. Staff training and required documents are in good order. All staff have received a criminal background check and have been properly associated to the facility. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted. Deficiencies noted. A copy of this report and appeal rights issued at the time of the visit..