Routine inspection·October 18, 2024

Licensing Program Analyst (LPA) Marcella Tarin and Licensing Program Manager Jackie Jin conducted an unannounced annual inspection visit at 9:45AM and met with Licensee Christina Williams. LPA and LPM toured the facility inside and out with the Licensee to include the living room, dining room, kitchen, resident bedrooms, bathrooms, and exterior. All emergency exits were observed to be clear of obstruction. LPA and LPM toured the kitchen area and observed two residents sitting at the kitchen table eating breakfast at 9:45AM. LPA and LPM 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 39.7 degrees F and freezer maintained at -8 degrees F. LPA and LPM observed toxins, sharps and chemicals locked and inaccessible to residents. LPA and LPM toured 4 resident bedrooms. 4 out of 4 resident bedrooms had beds, a dresser, functioning lights, storage space for personal belongings, clean bedding, and a chair. LPA measured hot water temperature, range of 109.9 to 118 degrees F for 2 out of 2 resident bathrooms. The facility was equipped with smoke and carbon monoxide detectors. Fire extinguishers were last serviced on 10/9/2023 and LPA observed extinguisher to be fully charged. LPA observed the facility first aid kit, and it was observed to be complete. The facility fire/earthquake drill log was reviewed, and drills are being conducted quarterly. The last fire drill was conducted on 07/05/2024. Facility has emergency disaster plan. LPA and LPM reviewed 4 residents Centrally Stored Medication and Destruction Records (CSMDR). LPA observed 4 out of 4 CSMDRs are complete with all medications accounted and documented. LPA and LPM observed the medication storage area was locked and inaccessible to residents in care. LPA and LPM reviewed 4 out of 4 resident records. LPA and LPM observed 4 out of 4 resident records to contain identification and emergency contact information, personal rights, TB results and consent forms. Residents (R2 and R4) records did not contain completed appraisal/needs and services plans. LPA advised Licensee to complete appraisal/needs and services plans. Residents R1 and R3 appraisal needs and service plan was not updated within the year. R1 and R3 have neurocognitive disorder. LPA reviewed 4 out of 4 staff records. LPA observed 4 out of 4 records as complete to include fingerprint clearance, health screening, TB result, personnel record, and staff training. Licensee Administrator Certification is current and expires on 11/26/2025. A deficiency was cited today per California Code of Regulations, Title 22. A Technical Violation was issued today. See LIC809D. Exit interview was conducted with Licensee Christina Williams. This report was provided to Licensee and appeals rights were provided.