Routine inspection·January 21, 2025

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct the facility's Required 1-Year annual inspection. LPA met with Staff Tomoko Yoshida. LPA toured the facility to include the hallways, resident bedrooms, bathrooms, recreation room, dining room, kitchen, and exterior. All staff present are fingerprint cleared and associated to the facility. LPA observed 5 residents in the recreation room watching tv and reading the newspaper. LPA observed the hallway temperature display at 71 degrees Fahrenheit. LPA observed 2 hallway exit routes are lit with sunlight from the windows above the hallway. LPA observed posters for complaint reporting, ombudsman, and Resident's Rights. LPAs toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator temperature maintained at 40 degrees F and freezer maintained at 0 degrees F. At 10:16AM LPA observed a damaged and discolored kitchen countertop area where food is prepared, next to the kitchen sink. LPA advised staff to repair counter top and to ensure the facility is in good repair. LPA toured 15 resident bedrooms. 14 out of 14 resident bedrooms had a bed, functioning lights, a dresser/table, a chair and space for personal belongings. 1 resident bedroom is being used as storage. LPA advised staff to update the facility sketch and submit to the Department by 1/31/2025. LPA measured water temperature for 6 resident bathrooms at 105 degrees F. LPA observed spider webs in the ceiling of the bathrooms, and dark spots on the shower floor (next to bedroom #8). LPA advised staff to ensure the facility is in good repair at all times. See LIC809-C LPA reviewed 3 staff records. 3 out of 3 staff records were complete and included background fingerprint clearance, health screening with TB result, staff training and first aid certification. LPA reviewed 4 resident records. 4 out of 4 resident records were complete and included emergency contact information, medical assessments, and needs and service plans. LPA also reviewed 4 Centrally Stored Medication and Destruction Records (CSDMRs). 4 out of 4 CSMDRs were observed to be complete with all medication documented accurately. LPA reviewed emergency drill logs. LPA observed the facility conducts their emergency drills quarterly. The last drill was completed on 1/16/2025. The facility's last fire inspection was conducted on 3/28/2024. The facility's fire extinguisher was last serviced on 09/05/2024. Facility has smoke alarms and carbon monoxide detectors present throughout the hallways. LPA requested the facility submit an updated facility sketch to the Department by 1/31/2025. A deficiency was cited today per California Code of Regulations, Title 22. See LIC809D. This report was reviewed with Staff Tomoko Yoshida and copy of this signed report and appeal rights were provided.