Routine inspection·September 28, 2023

Unannounced annual visit made out to this facility on 09/28/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility Care Operations Manager Kaylie McCortney since the facility designated Administrator, Rikki Perezchica, was unavailable at this time. A brief interview was conducted with the facility representative, Kaylie McCortney, at this time. It was learned that there were residents under the care of hospice(9) at this time while other residents were receiving services through home health (15) as well. This facility does have a hospice waiver approved for (15) residents and fire cleared for bedridden (2) and dementia care for residents at any given time. Current census was 180 residents. A tour of this facility was conducted alongside the facility Care Operations Manager. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator. Kitchen area was toured. Cabinets and drawers were reviewed. Food preparation stations, dishwashing station, and other areas intended for meal preps were toured. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe additional food storage units which were present and functional at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication room, located on the first floor, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications were discussed with the facility designated medication technicians at this time. The medication carts were observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restroom was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. It was learned that there were (7) different floor plans for residents on the Assisted Living portion of this facility. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Linen closet, located in the facility laundry area, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. This facility does not have a dedicated Memory Care unit at this time. Dementia diagnosed residents are integrated into the main census of Country Manor. Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 03/02/2023 by the local fire extinguisher company, Cisco Fire and Sprinkler, and in compliance at this time. First aid kits were observed to be present and contained all of the required components at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (5) facility resident files was conducted. A review of (5) facility personnel files 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