Routine inspection·August 2, 2023

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 10:06AM. LPA initially met with facility staff. Administrator Shila Pandey was contacted via telephone and arrived at the facility at 10:30AM. Entrance interview conducted. Beginning at 10:46AM, the 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 Combination smoke and Carbon Monoxide detector was tested at 04:28PM and was functional at the time of the visit. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 7 (seven) total bedrooms; 1 (one) of which is designated as a staff room and 6 (six) are private resident rooms. Staff room was observed locked. RESTROOMS: The LPA observed 3 (three) restrooms in the facility; 2 (two) are shared restrooms and one is a private restroom. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in all 3 (three) restrooms both in the morning and afternoon and measured lower than the required temperature. At 11:04AM, water temperature in the kitchen measured just above the minimum required temperature at 105.3 degrees Fahrenheit, but measured well below at 04:20PM. 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. A fireplace was observed to be adequately screened and inaccessible to residents. Fire extinguisher was observed to be fully charged and purchased Continued on LIC 809-C on 03/21/2023. Garage was observed locked and contained the laundry area, extra food, and additional storage. OUTDOOR SPACE: The backyard has a shaded seating area for resident use. There were no bodies of water noted. At 11:19AM, LPA observed the outdoor exit gate to be locked. LPA spoke with the Administrator about the gate being an emergency route out of the facility and cannot be locked. 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 food and water supply. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. RECORD REVIEW: Record review began at 11:31AM, records were reviewed for 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. LPA observed 2 (two) residents were identified as being bedridden on their physician's reports, however, the facility has fire clearance for 1 bedridden resident. 3 (three) staff files were reviewed; all 3 (three) staff files reviewed were complete. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control practices and emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency Disaster Plan was observed to be completed, but has not been reviewed annually. Emergency drills are conducted monthly, with the last documented drill on 06/30/2023. MEDICATION REVIEW: Medications were observed locked in a cabinet adjacent to the kitchen. Review began at 02:55PM. Medications for 3 (three) residents were observed. All 3 (three) residents' medications were observed to be maintained and administered in compliance with regulation. Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Two (2) civil penalties were issued, totalling $1000. Exit interview conducted. A copy of the report and appeal rights were provided