Routine inspection·April 21, 2023

On 4/21/2023 starting at 9:25 AM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with JOE, ISABELLA- Licensee and explained the purpose of the visit. The licensee administrators certificate is valid and expires on 11/28/2023. The facility’s fire clearance was approved for all four (4) ambulatory residents, two (2) non- ambulatory residents and two (2) hospice waivers. Upon entry, LPA observed two (2) staff and five (5) residents present during inspection. Starting at 10:20 AM, LPA toured facility with licensee including but not limited to four (4) bedrooms, three (3) bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 1 bedroom is private, and 3 bedrooms are shared. 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 residents’ common area bathroom was measured at 107.6 Degrees Fahrenheit. Residents’ bathrooms are equipped non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day supply of perishable foods. Sharps and toxins were locked and inaccessible to residents'. Smoke detectors and carbon monoxide detector were in operating condition. Fire extinguisher was observed last serviced on 3/4/2023. First aid kit was observed to be complete. Continue on Lic809-C Continued from Lic809 Starting At 11:20 AM, LPA reviewed 2 of 2 staff records. At 12:12 PM, LPA reviewed 5 of 5 residents' record. At 1:15 PM, LPA attempted to review a sample of 5 of 5 residents' medications, however, residents MAR was not filled out for the year of 2023 and LPA was not able to verify residents' medication. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalties. At 11:30AM, LPA observed S1 with no CPR training. At 11:40AM, LPA observed S2 with no First aid and CPR training in his file. At 1:10PM, LPA observed no MAR created for R1, R2, R3, R4, AND R5 for the year of 2023. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 4/5/2023: · LIC 308 Designation of Administrative Responsibility · LIC 500 Personnel Report · LIC 610E E mergency Disaster Plan (9 Pages) · Liability Insurance Exit interview conducted with Licensee, and a copy of this report provided along with appeal rights.