Routine inspection·June 20, 2023

Licensing Program Analyst (LPA) Kelly Dulek arrived unannounced to conduct a required annual visit. The LPA met with Executive Director (ED) Gena Grundeis and informed ED of the reason for the visit. Entrance interview conducted. ED indicated she has been working at the facility for approximately 2 and a half months, however the Regional Office did not receive notification in writing of a new ED within 30 days, per regulation. LPA discussed with ED paperwork required. All paperwork was provided during today's visit. Beginning at 11:11AM, the LPA, along with ED toured the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations. The following was observed: The facility is a three-story building. There are resident rooms on all three floors, units are designated for independent living residents on the third floor, assisted living residents on all three floors and a separate secured unit on the first floor is designated for residents in the memory care unit. Common Areas: There were no obstructions and/or tripping hazards observed during facility tour. The facility maintains a comfortable temperature throughout the building. There are fire extinguishers throughout the facility, which were fully charged and last serviced 11/02/2022. Hardwired smoke detectors, fire doors and sprinkler system are inspected monthly, with the most recent inspection completed on 06/05/2023. Planned activities are offered. Activity schedule is posted throughout the facility. All activity rooms and common spaces appeared clean and in good repair. Cleaning supplies and disinfectants are stored locked per regulation. At 11:16AM, a storage closet containing used sharps was observed to be unlocked and accessible to residents in care. A working telephone is present. The LPA observed the required postings in the common area. Resident Rooms: The facility consists of shared and private resident rooms, of which the LPA observed 10 Report Continued on LIC 809-C resident rooms; 2 in Memory Care and 8 in Assisted Living. All resident rooms observed were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Resident Restrooms : Each resident room contains its own private restroom; full restrooms were observed in Assisted Living and half-bathrooms in Memory Care, with a common shower room. Resident restrooms observed contained sufficient grab bars and non-skid surfaces. Water temperatures were checked in all resident restrooms observed, and measured within the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit. Outdoor Space: Multiple seating areas in both Assisted Living and Memory Care were observed with tables and chairs and shaded seating areas for resident use. Resident Record Review: Began at 12:40PM, the LPA reviewed 5 (five) resident records for documents including, but not limited to: physician's report, TB test, needs and service appraisals, admission agreements, and personal rights. 5 (five) of 5 (five) resident records reviewed contained all appropriate documents. Disaster Preparedness: LPA reviewed the facility's Disaster Preparedness binder. The facility's policies and procedures as it relates to Disaster Preparedness are adequate. Kitchen: At 02:50PM, LPA Dulek observed the kitchen/dining area. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food, including emergency supply. Infection Control: Not reviewed during today's visit Medication Review: Not observed during today's visit Staff File Review : Not observed during today's visit interviews: During today's visit, LPA interviewed 3 (three) residents. Staff interviews will be conducted during Annual Continuation visit. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.