Routine inspection·February 20, 2024

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Wendy Cornejo, Administrator. Facility currently has nine [9] residents on hospice which is allowable per the facility's Hospice Waiver. Facility contact information was reviewed. At approximately 9:30am LPA and Admin toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA and Admin observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and labeled. Cleaning supplies not stored with food items. Water temperature in sink(s) accessible to residents in care measured at 106 degrees F which is within the allowable range of 105 to 120 degrees F. Fire extinguishers were last inspected 11/21/2023. Smoke/Carbon Monoxide detectors and sprinklers located throughout the facility were tested and operational, last inspected 2/5/2024. Elevator permits expired 11/29/2023; however, annual inspection by State of CA, Dept of Industrial Relations is scheduled, LPA verified via email correspondence. Stairwells has evacuation chairs present. Facility’s last quarterly disaster drill was conducted on 2/7/2024. Facility has a backup generator for use during a power outage. At approximately 11:00am LPA conducted a review of five [5] resident records. All required documents present. Four [4] of out of the five [5] residents reviewed are on hospice; respective hospice care plans present. At approximately 2:00pm LPA conducted review five [5] staff files. All required documents present, required training completed. At approximately 12:30pm LPA conducted a spot check of medication and medication records. Medication is centrally stored in Medication carts which are stored in locked Medication room, refrigerator present for refrigerated medications. Report continued on LIC 809-C... Continued from 809... Wendy Cornejo Administrator Certificate 6018066740 expires 7/22/24. All fees are current as of this time. LPA and Admin discussed facility's Infection Control Plan and Emergency Disaster Plan. 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 Evidence of Liability Insurance No deficiencies cited during this inspection.