Routine inspection·September 12, 2024

Licensing Program Analysts (LPAs) Steve Chang conducted an unannounced annual inspection visit and met with Executive Director (ED) Shantela Yadao. LPA reviewed 5 resident files and 5 staff files. LPA toured the facility inside and out with ED. LPA observed license, ADM Certificate, and personal rights posters in the facility. LPA toured the first floor. LPA inspected the lobby, living room, common restrooms, dining room, kitchen, laundry room, and resident rooms. LPA toured the second floor. LPA inspected the activity rooms, chemical storage room, nurse room, salon room and resident room. LPA toured the third floor. LPA inspected activity room, game room, laundry room, and resident rooms. The facility has a incident at 3:00AM today. The faucet of room 327 was broken. The water came out, room #327, #329, #330, #328, nurse office in the second floor and room #115 at the first floor are affected. The facility fixed the issue this morning. The affected rooms are got dried. LPA checked all the affected rooms, and they are without problems. The affected rooms are waiting to dry. ED stated they should be fine and recover back to normal around noon time today. The room temperature of the facility was at 72 degree F. The temperature of the refrigerator was observed at 40 degree F, and the temperature of the freezer was at 0 degree F. Hot water was measured at 106 degree F. Medication room and medication carts were observed locked. Chemical rooms was observed locked. Knives closet was observed locked. Continue on LIC809-C. Page 1 of 2. Fire extinguisher was serviced on 08/15/2024. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Fire alarm system was tested and was working fine. Carbon monoxide detector was observed running out of battery, the facility fixed it before LPA finished the inspection. LPA tested the door delay opening for the memory care unit and it was working fine. The memory care unit backyard and assisted living unit back yard were inspected. Both have the delay opening gates. Deficiencies noted today. See LIC809-D An exit interview was conducted with ED. This report was provided to ED to review. A copy of this report was provided to ED. Page 2 of 2.