Routine inspection·January 7, 2025

On 01/07/2025 at 09:00AM, Licensing Program Analysts (LPAs) P. Manalo and L. Fontanilla arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Care Staff, Leonora Maquilan, and explained the purpose of the visit. Care Staff stated that the Licensee/ Administrator has been out of the country since 12/19/2024 and not available. LPAs toured facility inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which all 5 bedrooms are occupied by the residents. 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 was measured at 110.7 degrees Fahrenheit. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 09/12/2024. First aid kit was observed to be complete. Staff does not have access to the staff and resident files. Files were not available for review during the visit. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 01/21/2025 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 Infection Control Plan Continue to LIC809-C.. Continue from LIC 809.. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:10 AM, LPAs observed unlocked knives in the kitchen and unlocked insulin in the kitchen fridge accessible to residents. At 9:05 AM, LPAs observed that all staff and resident files were not available during the visit. At 9:15 AM, LPAs observed trash bags in the backyard and inside the garage that is not in the garbage bin due to an overflow. At 9:17 AM, LPAs observed the left side gate with a paddle lock. Staff admits that they lock the gate at night. Civil penalty of $500 is being assessed. At 9:20 AM, LPAs observed washing machine, stove, wheelchair, shower chair, RV, etc in the backyard. At 10:00 AM, LPAs observed R3 is on insulin sliding scale and unable to determine amount of insulin needed due to poor vision. At 10:15 AM, LPAs observed the Medication Administration Record not having an accurate record of dosages of medications 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.