Beginning at 12:30 P.M., the LPA, along with Licensee 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. This facility doesn’t have a staff room, facility will provide 24/7 care. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit.

OUTDOOR SPACE: The backyard is shared between this facility and another related facility. The shared yard has a covered outdoor area equipped with furniture for resident use. The facility does have a fountain, but it was observed to be empty at the time of the visit.

KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Emergency food and water supply are stored in the garage of another facility sharing the same outdoor property. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. At 12:34 P.M. hot water temperature measured 119.0 degrees Fahrenheit. Medication was observed locked in a kitchen cabinet. All cleaning supplies were observed locked and inaccessible under the kitchen sink. Hardwired combination smoke and carbon monoxide detectors were tested at 03:03 P.M. and were functional at the time of the visit. Fire extinguishers were observed to be fully charged and purchased on 08/12/2024.

Continued on LIC 809-C

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 2 (two) total bedrooms; one is a shared bedroom and the other is a private bedroom.

RESTROOMS: The LPA observed 2 (two) restrooms in the facility, both of which are designated for resident use. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in shared resident restrooms and measured within the required range. LPA observed a camera inside the master restroom. Licensee stated that staff use that “Baby monitor” to check on residents during the nighttime. LPA explained that per regulation, individual privacy shall be provided in all toilet, bath and shower areas. Licensee removed camera from the master restroom during today’s visit.

RECORD REVIEW: At 2:04 P.M. 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. LPA reviewed three (3) resident records. All records were complete and contained all required documents. Four (4) staff files reviewed were complete and contained all required documents.

MEDICATION REVIEW: At 3:50 P.M. medication reviewed started for all 3 (three) residents.Medications reviewed were observed to be maintained and administered in compliance with regulation. LPA observed licensee preparing medication containers for two (2) days in advance. LPA remined licensee that regulation states each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. Technical advice issued. Licensee agreed to use medication organizer only for the current day.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.

Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.