Beginning at 10:00 AM, the LPA, 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 is fully charged and recently serviced on 05/28/2024. Carbon monoxide detector was tested at 1:23 PM and was functional at the time of the visit. Fire alarm is centrally located and can not be shut off without the fire department on site at the facility.

KITCHEN: Kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of 7 (seven) days non-perishable and 2 (two) days perishable food. Knives were observed to be locked in a drawer. Cleaning supplies are located in a locked under-sink cabinet. At 10:02 AM, LPA began checking the food supply in the kitchen pantry. All food items observed were of good quality and not expired.

GARAGE: The garage is kept locked and inaccessible to clients in care. A washer and dryer were observed and laundry chemicals were properly stored. The facility maintains an adequate supply of emergency food and water for all residents and staff members.

BEDROOMS: There are 5 (five) total bedrooms in the facility; 2 (two) are designated as private resident rooms, 2 (two) are designated as shared 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. Report Continued on LIC 809-C

COMMON AREAS: This includes the living room and dining room areas. LPA observed common areas to be clean and properly furnished at the time of the visit. The living room has a properly screened fireplace. Exit doors contain alarms and all were functional at the time of the visit.

OUTDOOR SPACE: The backyard has adequate sitting areas with patio furniture including tables and chairs for resident use. The exit gates were observed to be self-latching and free from obstructions. There were no bodies of water on the premises. An outdoor shed was observed to be locked containing extra care supplies. A generator was observed outdoors for use in emergencies.

EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the emergency disaster plan. The facility’s policies and procedures as it pertains to emergency disasters are adequate with the last disaster drill having been conducted on 05/28/2024.

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. 4 (four) staff files were observed 1 (one) of which was missing their employee rights. All other staff files were complete. 6 (six) resident files were observed and all required documents were present. Resident 1 (R1) was observed to be a total care patient. The facility does not have an exemption to care for total care patients on file with Community Care Licensing at the time of this report.

MEDICATION REVIEW: Medications for 2 (two) residents were observed at 11:38 AM. All medications were properly recorded on the centrally stored medication and destruction record sheet. No deficiencies were noted during medication review.

Report Continued on LIC 809-C

During today's visit, LPA obtained a copy of the facility's liability insurance.

Pursuant to Title 22, CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Administrator was informed that failure to correct the deficiency may result in additional civil penalties. Exit interview conducted, report issued, and appeal rights provided.