Routine inspection·February 13, 2024

Licensing Program Analyst (LPA) Mita Partoza conducted an unannounced annual inspection at the facility. LPA met with administrator (ADM) Debbie Sazon and two staff. Current census 6 residents and 4 out 6 have neurocognitive disorder. During visit, LPA toured the facility to include the living room, dining room, kitchen, 7 bedrooms, including staff room and 6 resident's bedrooms. 3 bathrooms, garage, and backyard. The bathroom hot water temperature was measured at 113.4 degrees Fahrenheit to 120.2 degrees Fahrenheit. The kitchen water temperature is within range of 125 degree Fahrenheit. The room temperature in the facility ranges from 68 degree Fahrenheit to 75 degree Fahrenheit. LPA observed 2 days of perishable and 7 days non-perishable food supply as required by regulation. Toiletries such as toilet paper, paper towels, toothpaste are inspected and found to be in ample supply. Toxic materials such as laundry detergent, disinfectant are inaccessible to residents that are in a locked cabinet. Hallways have night lights and have ample lighting. LPA toured the facility and observed emergency exits and walkways are clear of obstruction and lawn is well maintained. continued on page 2 (LIC 809C) continued from page 1 of LIC 809 LPA tested the carbon monoxide and the smoke alarm and found them to be in good working condition. LPA randomly reviewed 3 resident's record (R1 to R3) R1 and R3 needs and appraisal plan is missing and R2 needs to be updated. LPA reviewed R1 to R3's centrally stored medication and destruction record (CSDMR) and found no discrepancy LPA randomly reviewed 3 staff record and observed that training are up to date, including the emergency disaster plan.. Deficiencies were cited per California Code of Regulations, Title 22 during today's visit. This report was reviewed with administrator Debbie Sazon. Page 2 of 2 End of report