Routine inspection·May 2, 2024

On 5/02/2024 at 12:50pm, Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced 1-Year Required inspection. LPA met with Sherwin Agustin, Caregiver, and explained the purpose of the visit. Giselle Adams arrived at 2:15pm. The Administrator currently holds a certificate (# 7001647740 ) that expires on 07/30/2025. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Caregiver including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of six (6) total bedrooms which one (1) bedroom is occupied by staff, and two (2) bathrooms. No bodies of water observed. A comfortable temperature is maintained at 72 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 108.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non skid mats. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 07/14/2023. Emergency Disaster Plan was last posted on 4/2/2024. First aid kit was observed to be complete. LPA reviewed four (4) staff files and three (3) resident files, which were all found to be complete. Continue from LIC 809 LPA observed the following deficiencies: · At 1:02pm, LPA observed medication and Clorox wipes in residents room. · At 1:05pm, LPA observed Lysol and cascade in a unlocked cabinet underneath kitchen sink. · At 1:10pm, LPA observed resident medication in an unlocked drawer located in the kitchen. At 1:13pm LPA observed paint, commode, branches, walker, sm table, 2 recliners, plastic drawers, shopping cart, kayak boat and a freezer from the back, side and front yard LPA requested the following documents to be submitted to CCLD by 5/10/2024. · Resident Roster · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan (9 pages) · Liability Insurance 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. Exit interview conducted. A copy of this report and appeal rights provided