Routine inspection·March 2, 2022

Unannounced annual visit made out to this facility on 03/02/2022 by LPA Charlie Yang and was met by the facility designated Administrator Paul Steve Hardin who was briefly interviewed. It was learned that this facility is licensed to accept and retain up to 15 ambulatory/non ambulatory residents at any given time. This facility is not vendorized to retain regional center residents at this time. Current census was 11 residents. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were reviewed to make sure that they were sufficient and in good working order able to meet the needs of the residents at this time. Kitchen area was toured. Cabinets and drawers were reviewed for adequate plates, cook ware, and silverware sufficient to meet the needs of the residents at this time. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. It was observed that additional food storage units were present in the carport area for nonperishable food items with an additional refrigerator and freezer unit. Tour of the facility resident bedrooms was conducted. Furniture and furnishings were observed to be functional and able to meet the needs of the residents at this time. Tour of the facility restrooms was conducted. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Grab bars and non skid mats were observed to be present as well as shower chairs for use by the residents. Medication cabinet, located in the kitchen area, was observed to be locked and made inaccessible to the residents at this time. Brief interview conducted with the facility designated Administrator in regards to medication management, ocumentation, and dispensing unto the residents in care. Fire extinguisher, located in the facility hallway adjacent to resident bedrooms, was observed to have been annually inspected by Jorgensen Company on 07/13/2021 and in compliance at this time. Linen closet, located in the hallway, was observed to contain towels, sheets, and linens sufficient to meet the needs of the residents at this time. A tour of the facility exterior grounds was conducted. Facility perimeter fence, side gates, and exits were reviewed at this time. The following forms and documents were requested by this LPA to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed, discussed and given to the facility designated Administrator, Paul Steve Hardin, at this time. Exit Interview