Health check·December 30, 2021

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced case management visit to the facility on 12/30/2021 at 11:30 a.m. LPA met with House Manager Kenroy Anderson and explained the purpose for today's visit. There are 6 residents currently living at the facility and 3 residents are currently on hospice care. LPA toured the facility kitchen, bathrooms, and bedrooms. LPA observed 2 days perishable food in the refrigerator, and 7 days non perishable in facility pantry. LPA observed working gas, electricity, and warm water at the facility. LPA observed locked medication cabinet with sufficient supply of medications for facility residents. LPA observed sufficient staff working at the facility. LPA interviewed the two staff members working at the facility both stated they had no concerns at this time and are being paid correctly on time twice a month. LPA requested Administrator Marinela Placintar submit the documents below to CCL Auditors within two days. 1. LIC 401/401A Form for the month of September 2021. 2. LIC 403/403 A Form for the month of September 2021. 3. All utility monthly billing statements including cable, water, garbage, electricity and gas for the period from July 2021 to September 2021. 4. Monthly Bank Statements for period from July 2021 to September 2021. 5. All food receipts for all the facilities for period from July 2021 to September 2021 6. Rental Roll including resident name and rental payment for the period from July 2021 to September 2021. There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. An exit interview was conducted with facility House Manager Kenroy Anderson and a copy of this report was left at the facility.