Routine inspection·December 21, 2024

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Nora Dennis. During the visit, LPA observed 2 residents and 1 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 2 restrooms and 4 residents bedrooms. LPA toured the facility garage, which is being used as a laundry area and a car storage area. The staff area of the facility was also inspected. The front yard and backyard were inspected. LPA observed a shed in the backyard, being used as a storage space. There was no obstruction to block the walkways. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degrees F, and hot water temperature was measured at 109 degrees F in hallway bathroom. Fire extinguisher was serviced in March 4, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on September 29, 2024. LPA reviewed facility records for 3 staff and 2 residents. LPA reviewed 2 resident medications and centrally stored medication records. LPA conducted interviews with 1 staff and 2 residents. LPA provided ADM with CDSS Flyer, "Important updates to Dementia Care and Miscellaneous Changes, effective January 1, 2025." Page 1 Out of 2. LPA requested a copy of the following documents; 1.LIC 500, Personnel Summary 2.LIC 308, Designation of Administrative Responsibility 3.LIC400, Affidavit Regarding Client/Resident Cash Resources 4. Liability Insurance 5. Qualifications of Administrator (Certificate) 6. Please review your facility program for updates (incorporating new laws and/or regulations) 7. LIC309, Administrative Organization No deficiencies cited during today's visit. This report was reviewed with Administrator Nora Dennis and a copy of the signed report was provided. Page 2 Out of 2. END OF REPORT.