Routine inspection·July 26, 2024

Licensing Program Analyst (LPA) Cuadra conducted an unannounced Annual Required – 1 yr. inspection visit and was greeted by Administrator, Jim Sirokman. Two residents are receiving hospice services. Annual fees are current and contact information was reviewed. Required postings observed. LPA/Administrator toured the facility, it was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms were furnished per regulations. Fire Extinguisher charged and service as of June 2024. Smoke detectors and carbon monoxide detectors throughout the facility were wired connected, tested and found to be operational. The facility is equipped with an additional sprinkler system. Last disaster drill was conducted on 7/10/24. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins stored in designated cabinets located in the laundry room and a storage shed located in the backyard which were both found to be locked and inaccessible to residents in care. There was a supply of hygiene products and paper products available for residents. Water was measured at faucets accessible to residents and measured between 114.3 and 115 degrees F which is within regulation. Medications located in secured carts in the staff office and were found to be secured. Medication and medication records were reviewed. All auditory alarms were operational. LPA initiated file review of five residents and five staff files. One out of five residents (R1) needs medical assessment to be updated (technical violation issued). Care plans are current. LPA/Administrator have discussed the importance of signatures on care plans as a best practice. Staff have current 1st aid/CPR training on file as well as 20 hours of additional required training. Administrator certificate for current Administrator Jim Sirokman #6045410740 ex pires on 7/1/2025. Administrator agreed to submit copies of the following documents by 8/2/24: LIC 308 Designated Facility Responsibility, LIC 500 Personnel Summary, LIC 610 Emergency Disaster Plan (if there are any changes) and Liability Insurance. No deficiencies cited during today's visit. Exit interview conducted with Administrator and a copy of this report was given.