Routine inspection·January 16, 2025

On 01/16/2025, at 10:25 AM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Care Staff, Elizabeth Alba, who phoned the Administrator and explained the purpose of the visit. Administrator gave authorization for staff to sign the report. LPAs toured facility inside and out 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. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. 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. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors were in operating condition during visit. First aid kit was observed to be complete. At 10:40 AM, LPAs reviewed 3 staff records and are associated to the facility. At 10:55 AM, LPAs reviewed 5 residents records. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 01/23/2025: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610 Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Continue to LIC809-C... Continue from LIC809... THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:27 AM, LPAs observed the temperature in the thermostat measured at 64 degrees Fahrenheit. At 10:30 AM, LPAs observed the hot water temperature measured at 129.2. At 10:35 AM, LPAs observed unlocked insulin in the fridge and unlocked medication in R5's room. At 10:37 AM, LPAs observed that the window screen in R5's room needs repair. At 10:40 AM, LPAs observed unlocked screwdriver in the backyard. At 10:47 AM, LPAs observed pieces of wood in the backyard that needs to be removed. At 11:00 AM, LPAs observed that all the residents did not have an Appraisal Needs and Services Plan. At 11:05 AM, LPAs observed that R4 does not have a doctor's order for the full bed rails. At 11:10 AM, LPAs observed that S2 and S3 does not have First Aid Certification. At 12:26 AM, LPAs observed that the fire extinguisher was last serviced on 11/22/2022. At 12:27 AM, during record review, LPAs observed that there was no Emergency Drills conducted. 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 Staff. Appeal Rights and a copy of this report provided.