Routine inspection·April 25, 2023

Licensing Program Analysts (LPAs) Trang Pham and David Marrufo, arrived unannounced to conduct an annual required one year inspection. LPAs met with Lola Bullock, Administrator. LPAs toured the facility inside and outside including the independent living, assisted living and memory care units. LPAs toured the common areas, kitchen, dining room, main courtyard, 9 bedrooms and 4 bathrooms. LPAs also inspected the outside storage area and attic which has emergency supplies, butane tanks, tools, cleaning supplies, all secured. 9 out of 9 residents' bedrooms inspected were observed to have functioning emergency pull cords. The signal system was tested and observed to be operating normally. Soap and paper supplies were observed to be available in the 4 observed bathrooms. LPAs tested the water temperature to be 117-118 degrees Farenheit in 4 bathrooms. Facility has functioning key pad system in the memory care unit. LPAs inspected the facility's kitchen, refrigerator and freezer. Cut food was observed to be sealed and ready. Prepared food was covered with preparation date written on lid. Pantry was observed to be stocked with at least 1 week's supply of non-perishable food and a perishable food supply of at least 2 days. LPAs observed that rooms are equipped with fire alarms and carbon monoxide detectors. Fire extinguisher observed to be last inspected in July 2022. During inspection of the memory care unit, LPA noted that there were 3 scissors in the bathroom cabinet for resident R1. LPA informed Administrator who removed and secured scissors in a locked cabinet. See LIC809-C for more information. Page 1 of 2. LPAs reviewed the centrally stored medication log for 9 out of 9 residents and found them to be complete. LPAs reviewed 7 residents' records, and 6 of the residents whose records were reviewed had dementia. 5 out of the 6 residents with dementia had physician's reports that were over a year old and outdated. LPAs reviewed 5 staff records. Staff S1 and S2 had expired first aid certifications. LPAs reviewed the fire drill report. The last drill was conducted on 3/23/2023. The facility records show the last annual fire alarm equipment test was conducted on 6/13/2022. A Technical Advisory note was issued. See LIC9102 for more information. Deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator Lola Bullock. A copy of the report and appeal rights were provided.