Routine inspection·January 27, 2024

On 1/27/2024 at 11:55am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-Year Required inspection visit. LPA met with Caregiver Marianne Martinez Caregiver and explained the purpose of the visit. LPA spoke with Administrator, Jacqueline Adams, via telephone and was given approval for Marianne Martinez to sign documents. The facility’s fire clearance was approved for five (5) non-ambulatory and one (1) bedridden resident. LPA toured the facility with including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. The facility consists of six (6) bedrooms and three (3) bathrooms. One (1) bedroom in use by staff and one bathroom is located in the garage. LPA did not observe any bodies of water. A comfortable temperature is maintained at 71 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 117.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 02/23/2022. Emergency Disaster Plan was last updated on 2/17/2020. First aid kit was observed to be complete. Fire drill was last conducted on 06/1/2022. Continued on LIC809C. Continued from LIC809. LPA reviewed all five (5) residents' medications. LPA requested the following documents to be submitted to CCLD by 2/5/2024. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance Resident roster LPA observed the following deficiencies: At 12:15pm, LPA observed during record review resident records were not available for review. Administrator stated via telephone that files were locked and staff can not access files. At 12:15pm, LPA observed during record review personnel records were not available for review. Administrator stated via telephone that files were locked and staff can not access files. At 12:20pm, LPA observed during review of medications there were medicines in bottles without labels and there was medication that was not listed on the medical administration record (MAR) At 1:45pm, LPA observed garage also being used for staff quarters. At 1:50pm, LPA observed 4 pieces of Sheetrock, pvc pipes, and wood in back yard on left side of house. At 2:05pm, LPA observed during record review fire drill last conducted on 6/1/2022. Continued on LIC809C. Continued from LIC809C. Deficiencies is 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 this report provided.