Routine inspection·January 7, 2025

On this day, January 7, 2025, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an annual required inspection. LPA met with licensee-administrator, Precilla San Miguel, licensee-administrator and explained the purpose of the visit. LPA toured the facility inside out with Precilla. LPA inspected the kitchen, dining area, activity/game room, bedrooms, bathrooms, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Facility has smoke and carbon monoxide detectors that were tested and observed functional. Hot water temperature in one of the bathrooms was tested and measured at 118 degrees Fahrenheit. Fire Drill last conducted 2/20/24. Fire Extinguisher observed fully charge dated 1/30/24. LPA reviewed 3 staff and 5 residents records and interviewed 2 staff and 4 residents. 3 out of 3 staff have CPR and TB on files. Medications were checked and compared with doctor's orders and LIC622 Centrally Stored and Medication Records. Facility does not handle residents' cash resources. LPA observed the following: -at 10:11 a.m. central storage for medications unlocked. -at 10:40 a.m. residents' medications in unlocked kitchen cabinet. -at 10:44 a.m. unlocked refrigerator with residents' medications. -at 10:50 a.m. observed knife in a cabinet unlocked. ..continued on 809C ..continued on 809C -at 10:53 a.m. peritoneal cleanser in one of the resident's bedrooms. -at 11:01 a.m. razor and ointment in the common bathroom. Administrator to submit the following updated/current documents by February 28, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate 5. R2 sign documents The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. *An immediate $250.00 civil penalty will be assessed on today's date for reported violation within 12month. * Exit interview conducted. A copy of the LIC421FC, this report and appeal rights provided.