Routine inspection·February 9, 2024

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Lilian Sacun. During the visit, LPA observed 4 residents and 2 staff. LPA toured the facility inside out with Staff S3, which included the Living room, kitchen, dining room, 2 restrooms and 4 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. While touring facility bedrooms, LPA observed bedroom #3 at approximately 1pm. S3 stated bedroom #3 is a staff bedroom. LPA observed the door to bedroom #3 does not have a lock. LPA observed a medication container on the dresser. (Photographs were taken.) 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 72 degrees F, and hot water temperature was measured at 110 degrees F in both resident bathrooms. Fire extinguisher was serviced in August 16, 2023. 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 February 3,2024. LPA reviewed facility records for 3 staff . While reviewing S3's file, LPA asked ADM for S3's training for 2023. ADM stated she did train S3 but she did not document any of S3's training's for 2023. Page 1 out of 2. LPA reviewed facility records for 3 residents. While reviewing resident records, LPA requested to review facility weight records for R1-R3. ADM stated the facility does not have weight records for the residents. LPA reviewed R1's records; R1's physicians report, dated March 4, 2022, states R1 has dementia. LPA asked ADM if she has a current copy of R1's physicians report, ADM stated that was the latest copy. LPA reviewed R1's Needs and Services Plan, dated March 1, 2023, which was not signed by R1's Responsible party. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 2 staff (S1 to S2) and 2 residents (R1-R2). Deficiencies are being cited during today's visit. This report was reviewed with Administrator Lilian Sacun and a copy of the signed report was provided. Appeal Rights were provided. Page 2 out of 2.