The facility is a single-story structure in a residential neighborhood. It consists of three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen, office, storage room, front yard, back yard with a shaded patio, and detached garage. All bedrooms have exit doors and have access to a wheelchair ramp. There were no hazards or obstructions on the exterior of the facility.

At 9:50am, LPA and staff toured the facility. There are no bodies of water or firearm/ammunition on the premises. All resident rooms were checked. Beds and bedding were in good condition, adequate lighting provided, and adequate storage for resident personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly. The shower was free of mold/mildew, there was adequate lighting, and sufficient toiletries that were accessible to residents. The water temperature in the bathroom measured 123.2F degrees. A comfortable temperature is maintained in the facility.

LPA observed the facility to be clean, sanitary, and appropriately furnished at the time of visit. Storage areas for cleaning agents, toxins, and sharps were inaccessible to residents. The kitchen was inspected and there is enough perishable and non-perishable food available for the residents.

Report Continued On LIC809-C

• 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.

LPA conducted a review of (5) resident records, (3) staff records and reviewed the facility disaster plan. LPA observed that residents had the following documents in their file: Appraisal/Needs And Service Plan, Admission Agreement, Physician Report, Identification And Emergency Information, Personal Rights, and Consent Forms. Staff records were complete with required documents and training. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (4) resident medication administration records, and medication, and did not observe any discrepancies at the time of visit.

LPA advised the facility to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance and other related issues. The inspection tool was not available on the inspection; LPA used a manual RCFE paper inspection tool. Technical difficulties in FAS.

DEFICIENCIES:

LPA identified the following deficiencies during inspection visit:

· Water temperature measured 123.2f degrees in the bathroom and 144.3f degrees in the kitchen. (Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105F degrees and not more than 120F degrees). Citation cleared on inspection visit.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 9099-D) for 87303(e)(2) Maintenance and Operation.

An exit interview was held, appeal rights were given, and a copy of this Facility Evaluation Report was provided to Arlene Feliciano, Administrator.