Routine inspection·May 30, 2024

At 11:45 a.m. on this day, May 30, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Joana Tiglao. LPA also met with other staff, Ernesto Cochico Jr., Ravina Olivete and Kristine Reta. LPA called and spoke with Milanette Escueta, administrator, over the phone, and authorized Joana Tiglao to be with LPA during inspection. Administrator arrived at around 12:05 p.m. Administrator submitted the LIC9282 Infection Control Plan which LPA received on May 16, 2023. LPA toured the facility inside out with Joana Tiglao. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, garage, 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. Hot water temperature in the common bathroom was tested. Fire extinguisher was observed fully charge with tag showed serviced 2/19/24. First aid kit inspected and observed complete with manual. Facility conducts fire drills monthly, and records showed last conducted 5/20/24. LPA reviewed 5 staff and 3 residents files, and interviewed 2 staff. Medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Residents P&I checked and compared with last recorded balance. LPA observed the following: -at 11:53 a.m., scissors on the top of the shelf in the dining area. -at 11:57 a.m., peelers in kitchen cabinets without lock. .......continued on 809C (page 2) Page 2 -at 12:00 noon, former resident's medications in unlocked garage. -at 12:07 p.m., hot water at 103.2 degrees Fahrenheit. -at 12:16 p.m., pieces of wood, metal grill, 2 pails of paint, Hydraulic oil, rusted cart, missing wood planks fence in the backyard. -at 12:17 p.m., side fence's wood planks coming off. -at 2:50 p.m., staff (S4) required 40 hours of training not completed within 4 weeks of employment. -at 4:30 p.m., all 3 residents' LIC625 Appraisal/Needs and Services Plan are over a year old. Administrator to submit updated/current copies of the following documents by June 13, 2024: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. Proof of Surety Bond coverage 5. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. Failure to submit proof of corrections (POCs) by plan of correction due dates, and any repeat violations within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.