Routine inspection·August 30, 2023

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 01:38PM. LPA met with facility Administrator Erika Catabay and discussed the reason for today's visit. Entrance interview conducted. At 01:53PM, LPA, along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Fire Extinguisher was observed to be fully charged and purchased on 04/22/2023. Hardwired combination smoke detectors and carbon monoxide detector were tested at 03:58PM and were functional at the time of the visit. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. LPA observed the fireplace in the living room, which was adequately screened. The facility laundry room and garage were observed to be locked. Garage contains emergency water supply, extra food, and storage. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. Outdoor shed was observed locked. Two (2) gates were observed to be locked, one on each side of the facility. KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food, as well as emergency supply. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. Report Continued on LIC 809-C BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 5 (five) total bedrooms; 4 (four) are for resident use and 1 (one) is designated as a staff room. RESTROOMS: The LPA observed 3 restrooms in the facility; 2 (two) are designated for resident use and one is a staff restroom. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in resident restrooms and measured within the required range. RECORD REVIEW: Began at 02:12PM, staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. 5 (five) resident records reviewed were complete and contained all required documents. 4 (four) staff files reviewed. 3 (three) of 4 (four) staff files reviewed did not contain proof of first aid training. MEDICATION REVIEW: Not reviewed during today's visit. EMERGENCY DISASTER PLAN: Not reviewed during today's visit. INFECTION CONTROL PLAN: Not reviewed during today’s visit. INTERVIEWS: Not completed during today's visit. Due to time constraints, LPA will return at a later date to continue the inspection. Pursuant to Title 22 of the CA Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted with Erika Catabay. Today’s reports and appeal rights were reviewed and provided.