LPAs Camara, Barutyan, and Byrne along with the HWD conducted a tour of the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations. The following was observed:

The facility is a three-story building. There are resident rooms on all three floors, units are designated for independent living residents on the third floor, assisted living residents on all three floors and a separate secured unit on the first floor is designated for residents in the memory care unit. There is a skilled nursing facility attached to the facility which is not under Community Care Licensing purview.

Common Areas: There were no obstructions and/or tripping hazards observed during facility tour. The facility maintains a comfortable temperature throughout the building. There are fire extinguishers throughout the facility, which were fully charged and last serviced 12/8/2023. Carbon monoxide detectors, hardwired smoke detectors, fire doors and sprinkler system are inspected monthly by the maintenance team. Johnson Controls conducted an annual inspection of the sprinkler system and smoke detectors 10/16/2023 - 10/18/2023. Evacuation drills are conducted monthly with all shifts with the last drill being conducted on 5/30/2024. The facility has a current emergency disaster plan which was adequate. Planned activities are offered and the activity schedule is posted throughout the facility. All activity rooms and common spaces appeared clean and in good repair. Cleaning supplies and disinfectants are stored locked per regulation. A working telephone is present. The LPAs observed the required postings in the common area.

Report Continued on LIC 809-C

Resident Rooms: The facility consists of shared and private resident rooms, of which the LPAs observed 10 resident rooms; 3 in Memory Care and 7 in Assisted Living. All resident rooms observed were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

Resident Restrooms: Each resident room contains its own private restroom; full restrooms were observed in Assisted Living and half-bathrooms in Memory Care, with a common shower room. Resident restrooms observed contained sufficient grab bars and non-skid surfaces. Water temperatures were checked in all resident restrooms observed, and measured 112.5 degrees Fahrenheit to 117.3 degrees Fahrenheit which is within the required range.

Outdoor Space: Multiple seating areas in both Assisted Living and Memory Care were observed with tables and chairs and shaded seating areas for resident use.

Resident Record Review: LPA Dulek reviewed 5 (five) resident records for documents including, but not limited to: physician's report, TB test, needs and service appraisals, admission agreements, and personal rights. 5 (five) of 5 (five) resident records reviewed contained all appropriate documents.

Kitchen: The LPAs observed the kitchen/dining area. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food, including an emergency supply.

Medication Review: The LPAs along with the HWD reviewed medications for three residents. All medications appeared to be given as prescribed, however staff do not correctly complete the Centrally Stored Medication and Destruction Record.

Staff File Review: LPA Dulek reviewed files for 5 (five) staff. The files were reviewed for documents including but not limited to: fingerprint background clearance, health screening, TB test, and training. Four out of the five files reviewed lacked the required number of training hours, including medication training and dementia care training.

interviews: The LPAs interviewed four residents and three staff. No concerns noted.

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. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.