Routine inspection·December 17, 2024

On 12/17/2024 at 2:30 PM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Direct Care Staff, Bernadeth Relon , who phoned the Administrator and explained the purpose of the visit. Administrator certificate is current, Administrator # is 7002125740 . The facility’s fire clearance was approved for all six (6) may be non-ambulatory and two (2) hospice waiver. LPAs toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 3 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. A comfortable temperature is maintained at 68 degrees Fahrenheit. LPAs 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 115.5 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. Centrally stored medication were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 12/10/2024. First aid kit was observed to be complete. Earthquake drill was last conducted on 11/09/2024. Fire drill was last conducted on 05/04/2024. At 2:42 PM, LPAs reviewed 5 clients and 4 staff records. LPAs reviewed client's P & I money with logs. The facility has surety bond sufficient to cover amount of cash being handled. At 03:02 PM, LPAs reviewed 4 staff records and 4 of 4 have current first aid training and all 4 are associated to the facility. At 3:20 PM, LPAs reviewed resident’s medications. All records were observed to be complete and up to date. 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 12/26/2024: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate THE FOLLOWING DEFICIENCY WAS OBSERVED DURING VISIT: At 2:30 PM, LPAs observed garden tools such as rake, spade, and etc., unlocked in the backyard. 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 Administrator. Appeal Rights and a copy of this report provided.