Routine inspection (multi-day)·December 3, 2024

On 12/03/2024 at 9:20 AM, Licensing Program Analysts (LPAs) P. Manalo and K. Nguyen arrived unannounced to conduct 1-Year Annual Continuation Inspection. LPAs met with Care Staff, Vincent Catequista, and explained the purpose of the visit. Care Staff phoned the Administrator who gave authorization through the phone to have staff sign. LPAs toured facility with Vincent Catequista including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. There are 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 93 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 and carbon monoxide detector were in operating condition during visit. Fire extinguisher was purchased on 11/12/2024. First aid kit was observed to be complete. LPAs reviewed 4 residents records. LPAs reviewed 4 staff records. LPAs reviewed a sample of resident’s medications. Continue to LIC809-C... Continue from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 12/11/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:00 AM, LPAs observed that R1, R2, R3, and R4 did not have all the documents in the file. At 10:30 AM LPAs observed that S4 does not have a CPR Certificate on file. At 10:50 AM, LPAs observed that the water temperature is measured at 98.3 degrees Fahrenheit at the shared bathroom. At 10:35 AM, LPAs observed knives and cleaning chemicals found unlocked and accessible to residents in the kitchen. At 11:05 AM, LPAs observed medication and paint found unlocked and accessible to residents in the bathroom. At 11:00 AM LPAs observed items such as bed spring, bed frame, bikes, cardboard, headboard, crates, and etc., in the side backyard. Continue to LIC 809-C... Continue from LIC 809-C... At 11:30, LPAs observed in Room #2 having half bed rail with no doctor's order for R4. 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 Care Staff. Appeal Rights and a copy of this report provided.