Routine inspection·January 20, 2024

On 1/20/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self, stated purpose of visit, and allowed entrance by Licensee Lilibeth Jacobs. Lilibeth Jacobs also serves as facility Administrator, #6050851740 expires 1/15/2025. There are currently six (6) residents in care. Five (5) residents were present during today's inspection. Residents were observed to be visiting with family, and relaxing in their bedrooms. Facility tour conducted with licensee. Facility has all private bedrooms. Facility observed to be in good repair, well lit, have adequate seating in all common areas, comfortable temperature, and to be odor free. All resident bedrooms observed to be fully furnished. Bathrooms toured, showers observed to have shower chairs, grab bars, and non-skid mats available. Toilet area also observed to have grab bars. Water temperature measured in bathroom at 116 degrees F. Kitchen toured, facility observed to have adequate food supply for residents in care. All sharps observed to be locked and secured in kitchen drawer. Cleaning supplies in kitchen cabinet are locked, secured, and inaccessible to residents. Garage is utilized as laundry room and additional storage, observed to be locked, secured, and inaccessible to residents. Medications observed to be locked and secured in dining room cabinet. Fire extinguisher present with a purchase date of 11/06/23. Carbon monoxide detector and smoke detector observed operational during inspection. Facility is also equipped with a pull station. Last fire drill conducted on 12/17/23 according to facility records. Outside of facility toured. No obstructions or hazards observed. The following documents were submitted to San Bruno Regional Office in 9/2023: LIC 500, LIC 308, LIC 400, LIC 610E, LIC 503 for staff, copy of Administrator Certificate and copy of Liability Insurance. LPA received updated copy of LIC 9020 during facility inspection. No deficiencies observed during inspection.