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25 | Licensing Program Analyst (LPA) Tao conducted an unannounced annual required visit at the facility. LPA met with Administrator, Toby Miclat, who assisted with the visit. The purpose of the visit was discussed. Facility is licensed to serve four (4) non-ambulatory and two (2) ambulatory residents, age 60 and above, of which one (1) maybe bedridden. Annual licensing fees are current. Administrator certificate is current and the expiration date is 10/12/23. Currently, one (1) hospice resident residing at the facility.
During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed. The facility is a single story house located in a residential neighborhood. LPA toured the facilities physical plant, indoor and outdoor. The facility has a living room, dining room, kitchen, five (5) resident rooms, two (2) bathrooms, and locked storage room. All residents’ bedrooms are furnished with appropriate furniture for residents’ comfort. The bathrooms are furnished with grab bars and nonskid surfaces. Common areas are observed for the ability to safely serve the needs of the residents. Smoke detectors and carbon monoxide detector are tested and operable. Fire extinguisher’s last service was on 11/10/21 and gauzes showed “1” fully charged. Facility maintains a comfortable temperature for residents. Auditory alarm devices to monitor exits are operable. No swimming pool or bodily of water at the facility. Backyard has a shaded area for resident use. Interior and exterior space is available to permit residents to wander freely and safely. Sufficient supply of perishable and nonperishable foods is observed. Knives, tools, sharp items are inaccessible to residents. Hot water temperature is 112.5 degrees Fahrenheit which is within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies are observed. Administrator stated there were no weapons or ammunition on premises. The first aid kit is fully stocked. Mandated documents and signages are posted in common areas. Medication are centrally stored in a locked cabinet in the storage room and inaccessible to residents. Resident records are stored in a locked cabinet and inaccessible to residents. Toxic substances are inaccessible to residents.
No deficiencies were observed per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed with Administrator, Toby, who’s signature on this form confirming receipt of these documents. A copy of LIC 809s report was provided.
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