Routine inspection·September 22, 2023

Unannounced annual visit made out to this facility on 09/22/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Brandi Vargas. The Licensee, Jamie Vargas, arrived shortly thereafter to this facility while this LPA was conducting this annual visit. Brief interview was conducted with the facility designated Administrator Brandi Vargas at this time. Current census was 4 residents. It was learned that there were (3) residents under the care of hospice at this time. This facility was approved for a hospice waiver to be able to accept and retain up to (6) residents under hospice care at any given time. A tour of this facility was conducted. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Brandi Vargas. The administrator certificate was due to expire on 09/01/024 and in compliance at this time. Kitchen area was toured. Cabinets and drawers were reviewed. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in the kitchen area, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications was discussed with the facility designated Administrator. This medication cabinet was observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperature was taken and measured to make sure that it was within the allowed range of 105-120 degrees. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Garage area was toured. This area also housed the washing machine and dryer for this facility's use at this time. Laundry area was toured. Cabinets storing detergents and bleach were observed to be locked and made inaccessible to the residents at this time. Fire extinguisher, located in facility kitchen area, was observed to have been annually inspected on 06/22/2023 by the local fire extinguisher company, USA Stanislaus Fire, and in compliance at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gate, and exits was conducted. It was observed that there was a shed present on facility grounds at this time. It was observed to be locked and made inaccessible to the residents at this time. A review of (4) facility resident records was conducted. A review of (3) facility staff records was conducted. The following forms and documents were requested 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 and a copy was given to the facility designated Administrator at this time. Exit Interview