Beginning at 02:47 PM, the LPA, along with the Administrator and facility staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS: There are four (4) bedrooms in the facility; three (3) are designated for resident use and one (1) is designated as a staff room. Two (2) resident bedrooms are private rooms, and one (1) resident bedroom is a shared room. LPA and the Administrator toured all four (4) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting.

BATHROOMS: There are two (2) bathrooms at the facility. Both are designated as shared/common resident bathrooms. Both bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. The water temperature was measured in both bathrooms to be between 117.0 degrees Fahrenheit and 119.1 degrees Fahrenheit which is in compliance with regulation. One (1) bathroom was observed to contain a locked under sink cabinet which contained cleaning chemicals and grooming supplies.

COMMON AREAS: This included the living room, dining room, and hallway. LPA observed the living room to be clean and properly furnished at the time of the visit. LPA observed the living room to contain the facility’s telephone, couches, and activities for resident use. The dining room was observed to be clean and contained adequate seating for resident use. Continued on LIC 809C.

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed the facility refrigerator to contain a bottle of expired milk and a bottle of expired chili sauce. LPA informed the Administrator of the expired items and the Administrator immediately disposed of the identified items. The LPA observed a fire extinguisher to be fully charged and last serviced on 10/31/2024 which is outside of the required annual timeframe. LPA informed the Administrator who contacted a technician and had the fire extinguisher serviced at the time of the visit.

OUTDOOR SPACE: The facility had one (1) emergency exit gate located on the side of the facility. LPA observed clear passageways for emergency exit use. The facility had adequate shaded outdoor seating for resident use. LPA observed the back yard of the facility to contain an appropriately secured laundry closet which housed a washer and dryer along with laundry chemicals. There is an additional building on the property that is not associated with the facility. LPA observed cameras throughout the outdoor areas of the facility.

INTERVIEWS: LPA interviewed two (2) clients one (1) staff member. The clients interviewed stated that staff treat them well and are attentive to their needs. No clients interviewed had concerns with the facility. LPA interviewed the staff member with the assistance of the Administrator acting as a translator. The staff member interviewed was knowledgeable on their role and responsibilities, the resident’s rights, and the appropriate reporting procedures for suspected abuse but struggled to appropriately identify the different forms of abuse. The Administrator agreed to conduct additional training with the staff on the topic of the different forms of abuse.

Due to time constraints LPA will return at a later date to conduct a file review, medication review, cash resource review, and to collect copies of pertinent documents.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited. (refer to LIC 809-D): Exit interview was conducted, a copy of the report was issued, and appeal rights were provided.