Routine inspection·June 11, 2024

Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced 1-Year Required visit on this date starting at 10:20am. LPA met with Administrator/Licensee, Evelyn Luciano. The Administrator currently holds a certificate (#6009840740) that expired on 1/7/2022. The facility’s fire clearance was approved for six non-ambulatory residents. LPA toured the facility with Administrator/Licensee including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 69 degrees F. 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 116.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/16/2023. One page of the Emergency Disaster Plan was posted on 5/25/2023. First aid kit was observed to be complete. LPA reviewed 4 staff files and 4 of 4 staff are associated to the facility but files are incomplete. LPA reviewed 4 residents records which were incomplete. Report continues on 809C Continued from LIC 809 The following deficiencies were observed during visit: -At 11:20am, LPA observed Room #5 is labeled as recreation room on facility sketch. Room #5 is being occupied by a bedridden (hospice) resident. -At 11:49am, LPA observed a fruit cutter, 3 ladders, wooden planks, rake, dresser, unlocked small storage units unlocked, a huge broken tree limb, commode, buckets, umbrellas located in the backyard. -At 1:15pm LPA observed staff records were not maintained at the facility. -At 1:30pm LPA observed facility has not conducted an emergency disaster drill since pre COVID per Administrator. -At 1:45pm LPA observed that facility has no CPR certified staff employed at the facility. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 6/18/2024: 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 (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. Exit interview conducted and a copy of this report and appeal rights provided.