Routine inspection·June 2, 2023

On 6/2/2023 at 9:45am, Licensing Program Analysts (LPAs) Jennifer Fain and Maja Jensen arrived at this facility unannounced to conduct an annual inspection visit. LPAs met with the Administrator Rowena Pablo and explained the purpose of the visit. LPAs Fain and Jensen inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is an RCFE facility with a current census of 5. Facility has a hospice waiver for 4 and today has 3 residents on hospice. Facility has 5 bedrooms and 2 bathrooms for resident use. Facility has a dining area off of the kitchen and a formal living room. Facility currently provides care for 0 ambulatory residents, 5 non ambulatory residents, none of which are bedridden. Water temperature reads 112.3 which is within the regulated temperature of 105*F to 120*F in the bathroom and room temperature reads 73 degrees Fahrenheit. LPAs observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were sanitary and furnished. Smoke and carbon detectors were in good repair. Fire extinguishers were serviced 1/31/2023 and are in compliance. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and accessible to staff. Continued on 809C During this inspection 5 of 5 resident files and 3 of 3 staffing files were reviewed for regulatory compliance. All staff files contained required contents including staff training requirements. All staff noted on LIC 500 were verified to have criminal background clearances. Resident files reviewed contained all required contents including but not limited to, medical assessments, and updated appraisal forms as required. 5 of 5 Resident files contained a "no refunds" clause. Facility’s liability insurance is current and up to date per regulatory requirements. Facility does not contain any bodies of water. LPAs observed personal rights, resident council and complaint information posted. Facility has appropriate internet access available for resident use. LPAs reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. LPA Fain requested and received updated copy of the facility lease agreement and liability insurance. Deficiencies are being cited from the Health and Safety Code (HSC). Failure to correct deficiencies may result in the assessment of civil penalties. Exit interview was held and a report and appeal rights were given to Administrator Rowena Pablo.