Beginning at 09:15AM, the LPAs, along with Licensee/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:

Fire extinguisher was purchased on 04/17/2024. Hardwired combination smoke and carbon monoxide detectors were tested at 9:37AM and all were functional at the time of the visit. No fire clearance concerns were observed.

BEDROOMS: There are 4 (four) total bedrooms in the facility; 1 (one) is designated as a shared rooms, 2 (two) are designated as a private resident rooms and 1 (one) is utilized as a staff room. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The LPAs observed a washer and dryer in unit next to the staff room.

BATHROOMS: There are 2 (two) bathrooms for resident use. 1 (one) is designated for shared resident use and the other 1 (one) is a private resident restroom. Restrooms were observed to be equipped with nonskid surfaces. Grab bars were observed in the bathrooms. At 9:22AM, the water temperature was measured in the shared bathroom and was within the required range at 115.8 degrees Fahrenheit.

COMMON AREAS: This includes the living room and dining room areas. LPAs observed common area to be clean and properly furnished at the time of the visit. An electric fireplace was observed in the living room and was inaccessible to residents in care.

Report Continued on LIC 809-C

KITCHEN/COVERED PATIO: The LPAs 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. The property has an enclosed patio area where emergency food and water supply are stored in the additional refrigerator and food storage. The LPAs observed water tanks outside the enclosed patio area with additional water supply. Refrigerators in the covered patio and dry food pantry were checked for proper labels and expiration dates and food labels had expiration dates clearly marked. At 9:26AM, LPAs observed an expired jar of mild cherry peppers in the pantry dating 12/2022. At 9:32AM, LPAs observed cleaning supplies to be located locked under the sink cabinet; however, the cleaning supplies are still accessible when locked. Knives and sharp objects were observed inaccessible in a drawer. At 9:34AM, LPAs observed an expired jar of mustard in the kitchen refrigerator dating 5/27/24. All expired items were discarded at the time of visit.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPAs 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. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly, with the last drill conducted on 06/18/2024.

RECORD REVIEW: Staff and client 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. Client files were complete at the time of the visit. 4 (four) staff files observed contained all documents. P&I funds also reviewed balanced according to balance record.

Report Continued on LIC 809-C

INTERVIEWS: During today's visit, LPAs were unable to interview clients as they were in day program.

Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties.

Exit interview conducted, report issued, and appeal rights provided.