Routine inspection·May 10, 2024

On this day, May 10, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Jonabelle Tolentino, administrator, and informed the reason for visit. Facility has LIC9282 Infection Control Plan. LPA toured the facility inside and out with the administrator. LPA inspected the common areas, bathrooms, shower room, living/activity room, kitchen, dining area, front, side and backyard. LPA randomly selected 8 bedrooms for inspection. Facility has adequate food supplies for 7 days of non-perishables and 2 days of perishables. Fire extinguishers were observed fully charge with tags showed serviced February 26, 2024. Facility has smoke and carbon monoxide detectors that were tested and observed functional. Hot water temperature in one of the ensuite toilets was tested, and measured at 116 degrees Fahrenheit. Facility conducts fire drills every 3 months, and records showed last conducted April 1, 2024. LPA reviewed 5 residents and 5 staff files, and interviewed 3 staff and 3 residents. Medications were checked and compared with doctor's orders on file and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. LPA observed the following: -at 12:27 p.m., missing drawers and drawer knob in one of the resident's room. -at 12:28 p.m., razor in the ensuite toilet in R5's room. -at 4:45 p.m., quantity of all of R1's 9 medications received by the facility does not match the quantity listed on LIC622. ......continued on 809C (page 2) Page 2 LPA received copies of the following updated documents on this same day: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. Proof of $3M liability insurance coverage Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with the administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.