Routine inspection·December 26, 2024

On 12/26/2024 at 10:25 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Alex Juntilla, and explained the purpose of the visit. The facility’s fire clearance was approved for all six (6) may be non-ambulatory and two (2) hospice waiver. LPA toured facility with Alex inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 4 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 68 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 107.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors were in operating condition during visit. Fire extinguisher was last serviced on 12/06/2024. Emergency Disaster Plan was last posted on 01/10/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 10/02/2024. At 10:55 AM, LPA reviewed 5 residents records. At 11:18 AM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and 3 of 3 are associated to the facility. At 1:20 PM, LPA reviewed samples of resident’s medications. Continue LIC 809-C... Continue from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 01/03/2025: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC9020 Register of Residents LIC 610E Emergency Disaster Plan Liability Insurance Auto Insurance THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:24 AM, LPA observed medication cabinet in the kitchen area unlocked and accessible to residents. At 10:46 AM, LPA observed second bolt lock on side gate leading to back yard. Civil penalty of $500 is being assessed. At 11:10, LPA observed that R1, R2, R3, R4, and R5 did not have an Appraisal Needs and Services Plan in file. At 12:45 PM, LPA observed the carbon monoxide detector not operating. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.