Routine inspection·June 4, 2024

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Annual Required visit and inspection of the facility. At the time of arrival, LPA was greeted by one (1) caregiver on duty, and five (5) residents present. Administrator Chamila Ruwanpathirana and Caregiver/Facility Manager, Fred DeLorenzo were present. LPA informed Administrator of the visit. Entrance interview conducted: The facility is a one-story Residential Care Facility for the Elderly (RCFE). The facility accepts residents with a dementia diagnosis; has a waiver for three hospice residents; and a fire clearance for six non-ambulatory residents and one bedridden resident. Currently, there are three residents on hospice and there is one resident who is bedridden residing in the facility. There are currently five (5) residents residing in the facility. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster and Resident’s Rights. LPA inspected the one-story 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, floors and floor coverings, and doors were checked. The inside of the facility was seen to be in good repair. The backyard has a patio table with chairs and an umbrella. Facility Manager stated a schedule will be created to keep the patio free of debris. LPA observed fire extinguisher was last serviced on 3/2/2023. Facility Manager stated the extinguisher will be serviced no later than 6/5/2024. The kitchen area was sufficiently stocked with two-day perishables and non-perishables for seven days. Snacks and beverages are available. Sharps are kept in a locked drawer located in the kitchen island. Snacks and beverages are readily available for Residents. Frozen foods are properly wrapped and stored appropriately. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. Please continue to 809-C, Pg 2. The front yard consists of a walkway, sitting area, and a lawn and garden area. The backyard consists of a large, concrete surface with a sitting area with one table and chairs. The front yard and backyard are conducive to visitations with family and friends. There are no bodies of water. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The washer, dryer, and cleaning supplies are kept in a locked laundry room and is inaccessible to residents in care The kitchen, living room, and dining area are neat and clean. The facility maintains a comfortable temperature. Medications, First Aid kit, and additional first aid supplies are kept in a locked centrally stored cabinet. Residents participate independently in music entertainment, games, baking, and outings to parks, restaurants, religious, and other local attractions. There are five private bedrooms. Bedroom #1 has a private bath. Bedrooms 2, 3, and 4 have a bathroom off the hallway shared by all residents. Bedrooms #5 and 6 have a shared bathroom off the hallway. The bathrooms have secure grab bars and no skid flooring. Each bedroom has a bed, nightstands, and lights and nightstand lamps to provide sufficient lighting. . All persons associated with the facility have criminal record clearance. Administrator certificate is valid. Records reviewed indicate all personnel and residents' records are current and up-to-date. The following deficiencies were observed (see LIC809-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies by the correction due date may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were issued at the time of the visit.