Routine inspection·June 20, 2023

On 6/20/2023 at 9:30AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with caregiver, Remedios Manalang and explained the purpose of the visit. The facility’s fire clearance was approved for 6 bedridden residents, of which 4 residents may be under hospice care. LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, and outdoor area. Smoke and carbon monoxide detectors were observed. Sprinkler system observed. Fire extinguisher was observed to be full and last serviced on 7/5/2022. One week of nonperishable and 2-day of perishable food supplies were available. LPA observed grab bars and non-skid mats in the bathrooms. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. First Aid kit is complete. The facility has a written emergency disaster plan. LPA reviewed 5 resident and 4 staff files starting at 11:00AM. LPA interviewed 2 residents and 2 staff starting at 1:30PM. At 10:15AM, LPA observed unlocked cleaning supplies in the laundry area. LPA also observed unlocked paints in the back yard. Staff locked up all the items during inspection. At 11:10AM, LPA observed R1 did not have a signed complete admission agreement on file. (Continue on LIC809C...) At 11:15AM, LPA observed R2's needs and service plan (ANS) is not signed and R5 does not have a reappraisal/needs and service plan. At 11:20AM, LPA observed R3 and R5 has incomplete medical assessments on file. Also, R5 does not have TB test on file. At 12:43PM, LPA checked Administrator Certification Program (ACP) website and observed Administrator does not have a current Administrator Certificate which expired on 7/31/22. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights were provided.