Routine inspection·December 6, 2023

At 11:55 am on this day, December 6, 2023, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA was granted entry by Noel Rocero, staff. LPA met with Maria Carmela 'Marla' Rocero, administrator, and informed the reason for visit. LPA also met with other staff, Rebecca Go. Administrator submitted the facility's updated Infection Control Plan which LPA received on August 27, 2023. LPA toured the facility inside out with the administrator. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, side yard and backyard. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Facility has smoke and carbon monoxide detectors that were tested, and observed functional. Hot water temperature in one of the bathrooms was tested, and measured at 105 degrees Fahrenheit . Facility conducts disaster drills quarterly, and records showed last conducted December 2, 2023. Fire extinguisher checked, and tag showed serviced December 5, 2023. LPA reviewed 3 staff and 5 residents files, and interviewed 2 staff and 2 residents. Medications checked, and compared with records and doctor's orders. Facility does not handle residents' cash resources. .....continued on 809C LPA received the following updated/current documents: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate The following deficiencies were observed and 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. -at 12:17 pm, rusted metal rack, empty pail, dusty commode, rusted metal, styrofoam container, piece of wood in the backyard. -at 12:30 pm, Glade spray, perotoneal cleanser and scissor i n unlocked bathroom cabinet. -at 12:34 pm, Lysol cleaning agent in unlocked ensuite residents' bathroom. -at 2:15 pm, 2 staff First Aid certificates expired and 1 staff no First Aid certificate on file. -at 2:20 pm, S2 has no LIC503 Health Screening and TB test result on file. -at 3:40 pm. R1, R2, R3, and R5's beds have half bed rails but no doctor's order on file. 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.