Routine inspection·May 29, 2024

On 05/29/24 around 01:45 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required Annual Inspection. LPA was greeted by Sumitra Khadka, Caregiver (S1) and Co-Administrator Shalini Bhutani (ADM) was telephoned and agreed to have S1 sign the report. The facility’s fire clearance was approved for six (6) non-ambulatory residents; hospice waivers for three (3). Upon entry LPA explained the purpose of the visit. LPA reviewed the resident roster, resident and staff files, and Emergency Disaster Plan. LPA observed a visitor sign-in log at the entry. LPA and S1 toured the facility, including but not limited to bedrooms, bathroom, kitchen, laundry room, common area, front yard and backyard. The facility consists of four (4) total bedrooms. All indoor passageways were free of obstruction. There aren't any bodies of water. A comfortable temperature for residents was maintained at 73 degrees Fahrenheit (F), and the water temperature measured at 114.6 for the comfort and safety of all the residents. The bathroom was safe, sanitary and in operating condition. Hand washing posters, paper towels, and soap observed at hand washing stations. Linen and hygiene supplies were available for all residents. PPE and paper goods remain sufficient. There is a minimum supply of 2-day perishables and 7-days of non-perishable foods. continued on LIC809C... . ..continued from LIC809 Smoke detectors/carbon monoxide were in operating condition during visit. Fire extinguisher last serviced on 01/22/24, first aid kit observed complete and next emergency disaster to be conducted on or before 06/01/2024. The following forms are to be updated and submitted to CCLD on or before 06/01/24: - LIC 610D Emergency Disaster Plan - Facility sketch - LIC 200 -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility (Reviewed) --An updated copy of Administrator Certificate(s) The following deficiency was observed. -At 3:20 PM, LPA observed there was not an updated fire clearance inspection for two (2) of the six (6) ambulatory and non-ambulatory residents. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in Civil Penalties. Exit interview conducted, Appeal Rights and a copy of this report provided to S1.