Routine inspection·January 17, 2024

Licensing Program Analyst (LPA) Zabel Chochian conducted a required annual visit. Upon arrival LPA met with Administrator Iris Van Kralingen and (2) staff. Reason for visit was stated. Between approximately 2:15pm-2:40pm, a tour of the physical plant was conducted with Administrator. All required postings observed posted on the wall in the entry area. LPA inspected the one-story facility for fire safety, personal accommodations, and food service. Smoke/carbon monoxide detectors were tested and found to be operable during visit. Fire extinguishers appear to be fully charged last serviced 03/06/2023. There are five (5) bedrooms total. One (1) bedroom is designated for staff use; two (2) shared and two (2) private bedrooms for resident use. The facility maintains a comfortable indoor temperature. Bedrooms were furnished appropriately to ensure the comfort and safety of the residents. Facility has two bathrooms for resident use with appropriate grab bars and nonskid mats. There is a sufficient supply of linens, and towels and toiletries. Auditory alarms on all exits were tested and function properly. Common areas including the living and dining areas observed for functionality and appear sufficient. Kitchen area: LPA observed sharps and chemicals in the kitchen to be locked and inaccessible to residents. Facility maintains two (2) day perishable and seven (7) day nonperishable food supply. LPA observed the backyard has a covered patio area with table and chairs for resident use. There is a self-latching gate on one side of the facility. There are no bodies of water or fire arms/ammunition on the premises. The last disaster drill was conducted on . (2:45pm) Resident files were reviewed for updated Needs and Services plans, medical assessments, admission agreements, and all other pertinent documents in their files. (3:30pm) Staff records were reviewed and noted to be complete for first aid certification, health screening documentation, employee rights and criminal record clearance. Staff annual training hours were not complete. Medications are kept in a locked cabinet in the kitchen area. Centrally Stored Medication logs observed. Physician’s orders observed on file for residents medication. First aid kit was observed complete. The following deficiency observed (See LIC 809-D) and cited from the Title 22 California Code of Regulations. Exit interview held. Copy provided.