Operation/Physical Plant: Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pool or similar bodies of water. The facility has sufficient indoor and outdoor space for resident activities and visitors. Outdoor activity space is shaded and protected from traffic. The facility is maintained at a temperature of 74 degrees F. Resident bedrooms were furnished with mattresses, bed linen, night stands, storage space, and bedroom lighting. Resident bathroom equipment were operating in safe and sanitary conditions. Bathrooms were equipped with non-skid flooring and grab rails. The facility is equipped with smoke detectors and carbon monoxide alarms, laundry equipment, covered fireplaces, and telephone service. Resident personal rights, Community Care Licensing complaint poster, Ombudsman poster, evacuation sketch, facility license, planned activities, menus, "oxygen in use" signs were posted in a common area. The facility maintains an infection control plan, disaster and emergency plan, and disaster drill training. The facility maintains a record of resident medications; however, LPA observed resident #1's (R1) insulin medication was stored in their bedroom refrigerator. Review of R1's physician's report reveals R1 is not able to store their own medication. LPA observed laundry detergent kept unlocked in the upstairs laundry area with no staff present. **continued on next page***

Care & Supervision: The facility has care staff coverage, 24 hours a day, 7 days a week. All staff working in the facility have criminal record clearance through the Department.

Record Review: LPA reviewed resident files for admission agreements, physician’s reports, appraisals, needs and services plans. LPA reviewed staff files for First Aid/CPR certifications, criminal record clearances, job related training, and health screenings. The Executive Director’s administrator certification is current.

Deficiencies were cited and a technical advisory was issued in accordance with Title 22 of the California Code of Regulations.

An exit interview was conducted where this report was discussed and a copy with appeal rights was provided to the Executive Director at the conclusion of the visit.