Routine inspection·June 4, 2021

Licensing Program Analysts (LPA's) Sarah Hurt and Ruth Wallace made an unannounced visit on this day for the purpose of conducting a Required - 1 Year Evaluation. LPA's met with Administrator. Administrator's Certificate which expires 02/15/2023 LPA's toured the facility grounds with Administrator. LPA's inspected 4 resident bedrooms. Bathrooms and hand washing areas were observed clean and sanitary. Non-slip textured surfaces were observed in shower. Water temperature measured at 106.0 F. Smoke detectors observed operational. The facility also has sprinkler system. Fire extinguishers were observed mounted and expires 10/01/2021. The facility was at a comfortable temperature for residents in care. LPA's observed required postings in prominent area for residents to view. LPA's reviewed food services and observed enough food on hand to meet the 2 day perishable, 7 day non-perishable requirement. Medication administration was observed with no concerns noted. Medications were centrally stored and inaccessible to persons in care. LPA's requested to review 5 resident files. Items reviewed but not limited to were: admission's agreement, Physician's reports, Needs and Services plans and TB tests, with no concerns noted. LPA's requested to review 3 staff files. Items reviewed but not limited to were health screening, TB test and Fingerprint Clearance as well as annual training. Aministrator is missing current First Aid/CPR/AED certificate. LPA reviewed emergency preparedness procedures with no concerns noted. Administrator reported that, the generator is tested monthly. LPA requested the following documents to be submitted within one week of annual visit: LIC 308 and LIC 500. Based on LPA's observations, the facility appears not to be in substantial compliance with Title 22 Division 6 of the California Code of regulations. Deficiency cited on 809-D. An exit interview was conducted with Administrator and a copy of this report and 809-D, appeal rights, and confidential list of staff and resident files reviewed were provided.