Routine inspection·December 2, 2021

Licensing Program Analyst (LPA) JoAnn Rosales conducted an unannounced Required - 1 year inspection. LPA met with Administrator Herbert Perey and Assistant Administrator Mischelle Perey. A physical plant tour was conducted to ensure there are no health and safety hazards. The facility is currently fire cleared for 6 non-ambulatory residents of which 2 may be bedridden. The facility was observed to be clean, safe, sanitary, and in good repair. LPA observed one central entry point designated for universal entry screening. Cleaning supplies were observed and infection control practices were discussed. An inspection of the common area, resident rooms and restrooms were conducted. The resident restrooms were observed to be clean and sanitary and in working condition. There is an adequate amount of perishable food. LPA observed fire extinguishers fully charged. Smoke detectors and carbon monoxide detectors were tested and operable. Grab bars were present in the bathrooms. Hygiene items are being provided. Outdoor area toured- passageways are free of obstruction. During facility tour at 11:19 am with Assistant Administrator Mischelle Perey LPA observed hot water temperature at 141.3 degrees F. in resident bathroom. During facility tour at 11:28 am with Assistant Administrator Mischelle Perey LPA observed resident #1 (R1)'s lactulose and lorazepam in the kitchen refrigerator accessible to residents. Assistant Administrator stated that they were unaware that the medications needed to be kept in a locked location. During facility tour starting at 11:32 am with Assistant Administrator Mischelle Perey LPA did not observe a sufficient supply of non-perishable vegetables and fruit as the facility had 2 small cans of potatoes, 1 large can of corn and 2 small cans of applesauce. Continued on 809C Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted. Today's reports and appeal rights were reviewed and emailed to the Administrator.