Routine inspection·March 28, 2024

On 3/28/2024 at 8:30AM, Licensing Program Analyst (LPA) A Gomez arrived unannounced to conduct a required annual inspection and met with Licensee/ Administrator Morenike Hamza. . The facility’s fire clearance was approved for 3. LPA toured facility with Licensee including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 2 bedrooms are occupied by the residents and 4 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 73 degrees Fahrenheit. 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 118.3 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 and sharps were locked and inaccessible to residents. LPA observed a hole in the ceiling and administrator stated that there was recent water damage but that they have an appointment to get it fixed next week. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 11/01/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 11/01/2023. At 8:40AM, LPA reviewed 2 residents records. At 9:00AM, LPA reviewed 2 staff records and 2 of 2 are associated to the facility. Report continues on LIC 809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 8:40AM during file review LPA observed R1's file having an expired physicians report, unsigned personal rights, and unsigned emergency medical consent form. R1's file had an expired physicians report, and missing the emergency medical consent form. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.