Routine inspection·March 29, 2024

On 03/29/2024 at 12:05PM, Licensing Program Analysts LPAs T.Syess-Gibson and L. Hall conducted an unannounced Annual 1-year required inspection. Caregiver Meledel Sumaylo contacted the Administrator by phone. LPAs toured the facility with caregiver Inoke Moa. Administrator, Gurpreet Matharu arrived at 2:00PM. The administrator currently holds a certificate (#6041833740) that expires on 08/15/2024. The facility’s fire clearance was approved for twelve (12) Non ambulatory and six (6) Bedridden residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of eleven (11) total bedrooms which Ten (10) bedrooms are occupied by the residents. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. A comfortable temperature is maintained at 75 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 119.5 degrees Fahrenheit. Night lights are maintained in hallways and passages to nonprivate bathrooms. Residents’ bathrooms are equipped with grab bars no non slip mats observed. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 09/08/2023. Emergency Disaster Plan was last posted on 11/18/2023. First aid kit was observed to be complete. Fire drill was last conducted on 11/03/2023. Continued on LIC809C. Continued from LIC809 The following deficiencies were observed: At 12:30 PM LPAs observed all three (3) of the shared bathrooms did not have non skid mats. At 12:32PM LPAs observed four (4) walkers, two(2) Wheel Chairs and one(1) Hoyer Lift located in the hallway blocking passageway. At 12:36PM LPAs observed beds did not have mattress pads. At 12:45PM LPAs observed there wasn't a Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days . At 12:50PM LPAs observed refrigerator unsanitary. At 12:55PM LPAs observed garbage inside of a grocery store basket on the side of the facility . At 12:56 PM LPAs observed wooden planks from broken fence on ground obstructing walk path. At 12:58PM LPAs observed Washer and Dryer on side of the facility blocking room number 2 exit. At 2:25PM LPAs observed unlocked medicine cabinet containing resident medication. At 4:45PM LPAs observed Medicine Administration Record was inaccurate. Six (6) residents records were reviewed, current, and complete. Six (6) staff records were reviewed. LPAs also reviewed a sample of medication. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 04/05/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report Continued on LIC809C. Continued from LIC809C LIC 610E Emergency Disaster Plan (last page) Residents roster Updated facility sketch Liability Insurance Deficiencies cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy the appeal rights and a copy of this report provided.