Starting at 10:12am, the LPA along with the Administrator 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:

KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food; properly stored. Refrigerator and dry food pantry were checked for proper labels and expiration dates. Knives and sharps were observed in a locked cabinet inaccessible to residents in care. At 10:15am, the kitchen sink was measured for hot water temperature, and it measured 111. 3 degrees Fahrenheit.

BEDROOMS: There are three (3) bedrooms for resident use and one (1) bedroom designated for staff only. One (1) resident bedroom is designated as double occupancy; and two (2) resident bedrooms are designated as single occupancy. The LPA observed all resident bedrooms to be properly furnished with a bed, appropriate and adequate bedding, nightstand, and sufficient lighting. Additional clean linens and towels were observed for resident use.

Report Continued on LIC 809C...

COMMON AREAS: The LPA observed the living room and dining room area to be furnished appropriately and all furniture was observed to be in good condition at the time of the visit. The facility maintained a comfortable temperature. The LPA observed required postings throughout the common space. Activities for residents were observed in the living room and tv room. There is a working telephone on premises. Facility has an adequate amount of emergency food and water. At 10:30am, smoke detector(s) and carbon monoxide detector were tested and were operational at the time of the visit. No obstructions or hazards were observed inside or out.

OUTDOOR / BACKYARD: There is a shaded area in the backyard with appropriate furniture for resident use. Washer and dryer were observed. Staff assist residents with all laundry needs. Detergents and cleaning solutions were observed in a locked cabinet at the time of the visit. The LPA observed one (1) refrigerator and one (1) freezer with additional food for residents in good condition. The exterior passageways were clean and clear of any obstructions. The LPA observed one (1) self-latching gate for emergency use. There is a pool that was observed to be locked and inaccessible at the time of the visit. The garage is maintained locked and inaccessible to residents in care.

Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan/IPP. All files were complete.

Report Continued on LIC 809C...

Administrator’s Certificate is active until 08/31/2025.

The facility is vendored by Tri-Counties Regional Center (TCRC) as a level 2-i home.

During today’s visit, the LPA conducted an interview with one (1) staff. No concerns noted.

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. Fire extinguisher was observed to be fully charged on 07/31/2024. Emergency disaster drills are conducted quarterly, with the last one conducted on 12/11/2024.

MEDICATION REVIEW: The LPA conducted a medication review at approximately 12:30pm. Medications are locked in a cabinet by the dining room. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications appeared to be given as prescribed at the time of the visit.

No citations issued. Exit interview conducted. Report was reviewed and a copy was provided.