Physical Plant: Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pool or similar bodies of water. The facility has sufficient space for resident activities; however, the facility does not have a up-to-date activity plan on file. The facility does not maintain resident's common areas free of mosquitos. Ten (10) resident bedrooms were inspected, LPAs observed that room#115 did not have a required chair. Ten (10) resident’s bathrooms were inspected, LPAs observed the following hot water temperatures: room#107 tested at 94 degrees f, room#110 tested at 91 degrees f, room# 115 tested at 101.6 f, and room# 137 tested at 98 degrees F. LPAs observed several roaches in resident room# 140 bathroom. The facility maintains a sufficient supply of bed linen, towels, and personal hygiene products for residents in care. The facility is equipped with operating smoke/carbon monoxide alarms, laundry equipment, and telephone service. Posters such as personal rights, the Community Care Licensing complaint information, Ombudsman poster, emergency telephones, and license were posted in a common area. Cleaning supplies, toxins, and sharps were kept inaccessible to residents in care.

Food Service: Kitchen and dining areas were maintained cleaned. Non-perishable and perishable food supply is sufficient for number of residents in care. Facility refrigerators and freezers were maintained in operating condition. The facility has posted a monthly menu.

Record Review: LPAs reviewed (6) resident files. LPA's observed resident #1(R1), resident #2(R2), resident#3(R3), resident#4(R4), and resident#5(R5) did not have admissions agreements on file. LPAs observed resident#6 (R6's) physicians report was not signed by the resident and/or legal representative. LPAs reviewed (6) staff files for First Aid/CPR certifications, criminal record clearances/exemptions, training, and health screenings. The Administrator’s certification is current. The facility has a emergency and disaster plan on file; however the facility did not have a current disaster drill conducted with staff on file for review.

Based on LPAs observations and records reviewed, deficiencies are being cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted where this report (LIC809) and a plan of correction were discussed with the Assisting Administrator. Copies of the reports were provided with appeal rights to the Assisting Administrator at the conclusion of the visit.