Routine inspection·February 1, 2024

On this day, February 1, 2024, at 11:30 a.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Sheilha Muniz, business office manager, and informed the reason for visit. LPA also met with other staff, Corazon Bugarin, Rosalita Llegado and Josefino Josue. Juliana Taburaza, administrator, arrived at 2:00 p.m. Administrator submitted the LIC9282 Infection Control Plan on June 30, 2022. LPA toured the facility inside out with the business office manager. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. 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 105 degrees Fahrenheit. Fire extinguisher was observed fully charge with tag showed serviced 10/23/23. Facility conducts disaster drills monthly, and records showed last conducted 1/02/24. LPA reviewed 5 residents and 5 staff files, and interviewed 3 staff and 3 residents. Medications were checked, and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Residents' P&Is were checked and compared with records. ...continued on 809C LPA observed the following: -at 5:25 p.m., resident (R3) has 2 orders for Ferrous Sulfate on same date - one was 1 tab 1x daily and 1 tab 2x daily. Label for this medication at facility's hand showed 1 tab daily or as directed, and facility administers once daily. Administrator to submit copies of the following updated/current documents by February 15, 2024: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate 5. Proof of Surety Bond coverage Deficiency is cited from Title 22 California Code of Regulations, and listed on 809D. Failure to submit proof of correction by plan of correction due date, and any repeat violation within 12 month period may result in civil penalties. Deficiency and plan and proof of correction were discussed with the administrator and business office manager. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.