Routine inspection·July 6, 2023

License Program Analyst (LPA) Hansen arrived unannounced to conduct an Annual Required – 1 yr. visit of the facility. LPA was welcomed by Licensee/Administrator Doug Cattich. There is a total of 9 residents, 4 are dementia residents. There is no resident currently on Hospice. LPA toured the facility on 7/6/2023 at 10:40 AM with Licensee/Administrator Doug Cattich; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices, and all doors were activated at the time of the visit. Fire Extinguisher was found to be last charged on 4/27/2023 at the time of the visit. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured between 112.6 degrees F and 115.3 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 2 of 2 resident’s bathrooms while touring facility on 7/6/2023 at 10:55 AM. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in the laundry room of the facility. Dangerous items are stored inaccessible to residents with dementia. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with individual towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings. Medications were centrally stored in two locked cabinets in the facility kitchen by front living room of the facility. A review of five resident & four staff records as well as two resident’s medications was conducted. LPA reviewed resident’s files at 12:30 PM on 7/6/2023 and learned that 5 of 5 residents have an updated reappraisal/needs & care plan, TB and physician’s assessments on file as required by Title 22 Regulation. Continued on LIC 809-C LPA reviewed a sample of staff records at 1:15 PM on 7/6/2023 and learned that all facility staff present and other individuals who require caregiver background checks have received criminal record clearances or exemptions. In addition, Direct care staff at the facility have received the additional training required. LPA was presented with proof of CPR & 1 st Aid certification for staff that files were reviewed. Doug Cattich Administrator Certificate # 6007381740 expires on 8/23/2023. Disaster Drills have been conducted quarterly with the last one being conducted on 4/4/2023. LPA initiated a file review of five resident files and four personnel files but were unable to complete. LPA was also unable to review medication and will return at a later date to complete annual inspection. No deficiencies cited during today's inspection.