Post-licensing visit·March 11, 2025

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced post-licensing visit to this facility at 11:00AM. LPA met with co-Administrator Molly Buck. Entrance interview conducted. Beginning at 11:28AM, the LPA, along with co-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: BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 6 (six) total bedrooms, all of which are designated for private resident use. RESTROOMS: The LPA observed 4 (four) restrooms in the facility; 2 (two) are shared restrooms and 2 (two) are designated for private resident use. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and slip resistant surfaces. Water temperature was measured in the common restroom and measured at 116.2 degrees Fahrenheit. KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives and other sharps were observed locked in a kitchen drawer. Cleaning supplies were observed in a locked under-sink cabinet. Fire extinguisher was observed to be fully charged and purchased 09/23/2024. OUTDOOR SPACE: The back yard area is enclosed. One gate was observed to be self-closing and self-latching. The other gate was locked and is not used as a passageway or resident exit. The backyard contains a shaded seating area and appropriate outdoor furnishings, as well as outdoor activity supplies. The backyard has a pool, which was properly fenced and locked. Report Continued on LIC 809-C RECORD REVIEW: Began at 12:15PM, 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. 4 (four) resident records reviewed were complete and contained all required documents. 5 (five) staff files were reviewed; 1 (one) staff file reviewed did not contain proof of fingerprint background clearance transfer prior to employment. All other staff files reviewed were observed to be in compliance. MEDICATION REVIEW: Began at 03:00PM. Medications for 2 (two) residents were observed. No discrepancies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control practices. The facility’s policies and procedures as it pertains to infection control are adequate. LPA also reviewed the facility's emergency disaster plan, which was observed to be complete. Emergency disaster drills will be conducted quarterly. INTERVIEWS: Throughout today's visit, LPA interviewed both residents and staff. No concerns were noted. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to LIC 809-D.) Civil penalty issued in the amount of $500. Exit interview conducted, appeal rights discussed and a copy of this report and appeal rights were provided.