Beginning at 11:14AM, the LPA, along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

Hardwired smoke detectors and separate carbon monoxide detector were tested at 02:00PM and were functional at the time of the visit. Fire extinguisher was observed to be fully charged and purchased on 11/16/2023.

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 6 (six) total bedrooms and a Lanai; 5 (five) bedrooms are for resident use and 1 (one) is designated as a staff room.

RESTROOMS: The LPA observed 4 (four) restrooms in the facility; 3 (three) are for resident use and 1 (one) is designated for staff use. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in 1 (one) resident restroom and measured within the required range.

COMMON SPACES: The garage was observed locked and contained emergency food supply and storage. Cleaning supplies were observed to be locked in the laundry room and properly stored at the time of the visit. In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, both living rooms and dining room furniture was observed to be in good condition. A fireplace was observed and was adequately screened. The LPA observed the required postings in the common area.Report Continued on LIC 809-C

OUTDOOR SPACE: The backyard has a covered outdoor area equipped with furniture for resident use. Empty jacuzzi and pond are located in a fenced area inaccessible to residents. All exits and passageways were observed to be free of hazards.

RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. 5 (five) resident records reviewed were complete and contained all required documents. 5 (five) staff files were reviewed. 1 (one) staff record reviewed did not contain proof of initial 20 hours training, nor first aid training; all remaining records were complete and contained all required documents.

INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated annually, as required. Emergency drills are conducted, with the last drill documented on 02/01/2023.

MEDICATION REVIEW: Medication cabinet is located in the kitchen. Although the lock was observed to be engaged, the medication cabinet easily opened, rendering the medications accessible to residents. Medications for 2 (two) residents were observed. Both 2 (two) of 2 (two) residents' medications were observed to be labeled and administered in compliance with regulation.

INTERVIEWS: Throughout the visit, LPA interviewed 2 (two) staff and 1 (one) resident.

During today's visit, LPA requested a copy of the facility's LIC 500 and Liability Insurance, which will be provided to the LPA via email.

The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Facility staff was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.