Routine inspection·October 12, 2023

At approximately 8:30AM, Licensing Program Analyst (LPAs) Chris Arnhold and Christi Coppo made an unannounced annual required inspection of the facility. LPAs met with Executive Director Angie Smith. At approximately 9:00AM, LPAs and Executive Director toured the building and grounds which was found to be clean and in good repair. LPAs observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPAs observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in a locked storage closet. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire extinguishers inspected were charged. Combination smoke/carbon monoxide detectors were present and found to be in working order. Facility has fire sprinklers throughout and were inspected 10/12/2023. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure. At approximately 11:30AM, LPAs reviewed 5 resident records and found all records have current physician's reports (LIC 602) and Appraisal Needs and Services Plans, as well as current and signed admission agreements. At approximately 1:05PM, LPAs reviewed 5 staff records. Five out of five records did not contain documentation of completed training records as required. Evidence of current first aid and CPR training were current. Continued on 809C At approximately 2:30PM, LPAs reviewed the facility emergency disaster plan with staff. Facility has a generator to supply power during an outage. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has the required evacuation stair chairs in place. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducts and documents disaster drills quarterly. 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 Facility Responsibility Evidence of current Liability Insurance received during visit Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Executive Director Angie Smith and Appeal rights were given.