Beginning at 9:33AM, the LPA, along with the Caregiver 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:

Fire extinguisher is fully charged and was last purchased 07/11/2024. Hardwired smoke and carbon monoxide detectors were tested at 09:49AM and all were functional at the time of the visit. LPA observed exit alarms by all doors which were functional and operating.

KITCHEN: LPA inspected the kitchen at 9:32AM. Knives are locked in a drawer next to the sink and cleaning supplies are stored inaccessible in a locked cabinet under the sink. Kitchen appliances were in operable condition. The facility has a sufficient supply of 2 (two) days perishable and 7 (seven) days non-perishable food. Food was stored at appropriate temperatures.

BEDROOMS: There are 3 (three) total bedrooms in the facility and all are designated as shared rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting.

BATHROOMS: There are 2 (two) total bathrooms, of which 1 (one) is attached to resident room. Restrooms were observed to contain nonskid mats. At 9:45AM, LPA observed suction grab bars by the showers which were loose and not functioning properly. Water temperatures in both bathrooms were measured between 118.5 and 118.7 degrees Fahrenheit, which is within the required range. LPA observed storage space closets in hallway containing clean linens for resident use. Report Continued on LIC 809-C

OUTDOOR SPACE: The backyard has a covered patio area with furniture including a table and chairs. There were no bodies of water on the premises. At 9:52AM, LPA observed the exit door outside to self-latch but failed to self-close.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 07/01/2024.

RECORD REVIEW: LPA began record review at 10:25AM. LPA reviewed 5 (five) out of 5 (five) resident files and 4 (four) staff files 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. All resident and staff files were complete and had no missing documents.

MEDICATION REVIEW: Medications are centrally stored and locked in a cabinet in the living room. LPA began medication review at 12:02PM and medications for 3 (three) residents were observed. 3 (three) out of 3 (three) resident medications observed were labeled and stored properly. PRN medications for 3 (three) out of 3 (three) residents observed were not properly documented at the time of the visit. 2 (two) medications for Resident #1 (R1) were not documented on the centrally stored medication and destruction record.

INTERVIEWS: During today's visit, LPAs interviewed 1 (one) staff and 2 (two) residents.

During today's visit, LPA obtained a copy of the facility's liability insurance.

Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.