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25 | Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met Tokie Ayabe, Licensee, who assisted with the visit. The facility has a capacity of six (6) residents. It is licensed to serve elderly residents age 60 and above, approved for 6 non-ambulatory residents. The facility has two (2) Hospice Waiver on file. Annual licensing fees are current. LPA discussed the purpose of today's visit.
Investigation consisted of used CARE tool, toured the facility, reviewed food supply, reviewed staff/residents files, and reviewed medication.
The facility is a two-story building consisted of: first floor, there are four (4) resident rooms, office, activity room, living room, laundry area, kitchen, four (4) resident bathrooms, and dining room; second floor, there are four (4) staff rooms and two (2) staff bathrooms. Residents' medications were centrally stored in the office, locked and the records are current. Resident bedrooms had furniture, lighting fixtures and personal storage space as required. Bathrooms inspected were clean, operable, and furnished with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 116.0 degrees Fahrenheit which was within Title 22 Regulation guidelines. Last fire drill was conducted on 5/29/23. Sufficient supply of perishable and non-perishable foods was observed.
A dual device of smoke detectors combined with carbon monoxide detectors were tested and operable. Fire extinguishers were fully charged and last service was on 1/9/23. No bodies of water observed.
No deficiencies were cited per California Code of Regulations, Title 22. An exit interview was conducted. This report is discussed and provided to facility Licensee, whose signature on this form confirm receipt of these documents. |