Routine inspection·November 7, 2023

At approximately 8:33am Licensing Program Analyst (LPA) Christi Coppo and arrived unannounced to conduct a required Annual inspection and was greeted by Chey Ivan, Administrator and Clayton Anderson, Licensee. Facility currently has 5 residents. Facility contact information was reviewed. At approximately 9:00am LPA and Licensee toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA and Licensee observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Celery and other vegetable bag was browning and not edible. Licensee threw the browning bags of celery and vegetable away immediately. One head of cabbage had black spots and patches. Licensee threw cabbage away immediately. Food was found to be stored in a safe manner with open items covered and labeled. Kitchen cabinet containing cleaning supplies was locked. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required bath mats and grab bars. Water temperature in sink(s) accessible to residents in care measured at 116.1 F and 106.2 F degrees which is within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected August 1, 2023. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Exit doors and sliding doors have an auditory alert system that was functional at time of inspection. Facility conducts quarterly disaster drills. Facility has a backup generator for use during a power outage. At approximately 11:15am LPA and Administrator conducted a review of 5 resident records and 1 staff record. Residents R1, R2, and R3 all have diagnosis of dementia but their LIC602 Medical Assessments were all not current as required per Title 22 regulation 87705(5). Report continued on LIC 809-C Report continued from LIC 809.... At approximately 12:50pm LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored in a 2 locked cabinets in the kitchen area. Chey Ilan Administrator Certificate 6018531740 expires 08/07/2024. All fees are current as of this time. Fee renewal due January 2024. LIS pin printed and given to Licensee. LPA and Licensee discussed facility's Infection Control Plan and Emergency Disaster Plan. Licensee verified no updates needed. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Copy of Deed or Mortgage Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given