Routine inspection·April 5, 2023

Unannounced Annual visit conducted on 04/05/2023 by Licensing Program Analysts (LPAs) Kimberly Viarella and Charlie Yang to this facility. LPAs were met by the designated Facility Administrator, Lidia Hiriscau (Certificate # 6012651740, expires on 03/16/2024) and a member of her staff. A brief interview followed. The current census was 5 residents with 3 non-ambulatory, and 2 hospice residents. LPAs proceeded to tour the facility to ensure the health and safety of the residents in care. LPAs toured the kitchen and instructed the designated facility administrator to open all of the cabinets and drawers. At this time, knives resided in a locked drawer and were inaccessible to residents. The food supply was then inspected. The contents of the refrigerator and pantry area were reviewed. At this time, LPAs observed 7 days of non-perishable food and 2 days of perishable food. Cleaning supplies were stored in a locked cabinet under the sink. LPAs observed that medications were stored in a separate locked cabinet and inaccessible to residents at this time. The Medication Administration Record and Dispensing Log was reviewed, and policies and procedures were discussed. First Aid kit was also inspected and found to be complete at the time of inspection. The tour continued to the 4 resident bedrooms. Each contained the required furnishings and included a bed, night stand, chest of drawers, chair and sufficient lighting. LPAs opened drawers to ensure that medications or sharps were not present. Bedrooms each had a private bathroom.. LPAs observed that the bathrooms contained paper towel dispensers, grab bars, and non-skid surfaces in the shower areas. Cabinets underneath the sink were inspected to ensure that they were free of toxic chemicals. The hot water temperature was measured in the first bathroom closest to the kitchen. It measured 115 degrees and within the required range of 105-120 degree Fahrenheit per regulation. LPAs inspected the laundry room which was locked and inaccessible to residents at this time. LPAs observed linens in a sufficient amount for the residents in care. The fire extinguisher was last inspected on January 30, 2023 by Jorgensen CO. LPAs observed that the facility had the required number of carbon monoxide and smoke detectors. LPAs inspected the exterior of the building and it was found to be free and clear of obstacles. Window screens were present and in tact. There were no bodies of water present. The yard was enclosed by a fence and there was a covered patio area for resident use. The 4 sheds on the premises were all locked at this time. LPAs requested access and inspected each. Two sheds held facility supplies, 1 contained tools for facility maintenance and 1 contained a lawn mower and garden supplies. A file review was completed for 5 resident files and 4 staff member files to ensure compliance. The following forms and documents were requested to be updated and submitted into CCL at Kimberly.viarella@dss.ca.gov for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 And a recent copy of the facility’s liability insurance. There were no deficiencies observed or cited during the inspection. An exit interview was conducted with the designated Facility Administrator and a copy of this report were given.