Routine inspection·August 20, 2024

On this day, August 20, 2023, at 2:00 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA was granted entry by Harold Dimaguila, staff. LPA met with Emelita Dimaguila, administrator, and informed the reason for visit. Facility has Infection Control Plan that was submitted on August 2, 2022. 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. Fire extinguisher purchased on was observed fully charge and purchased on Carbon monoxide and smoke detectors were tested and observed in operating condition. Hot water temperature in the common bathroom was tested and measured at 118.5 degrees Fahrenheit. LPA reviewed 5 staff and 1 residents files, and interviewed 1 resident. Facility does not handle residents' cash resources. Medications checked, and compared with doctor's order and LIC622 Centrally Stored Medication and Destruction Records. LPA observed the following: -at 2:05 pm, staff who stated she's been at the facility since Sunday, 8/18/24, is not fingerprinted. -at 2:12 pm, scissors and Vicks vaporub in the table in the living room. -at 2:14 pm, peeler, grater in kitchen drawer without lock. -at 2:15 pm, staff's medications in another kitchen drawer without lock. ......continued on 809C (page 2) Page 2 -at 2:19 pm, resident's medications in the refrigerator in the kitchen. -ar 2:25 pm, disinfectant spray and Polident denture cleaner in bathroom cabinet without lock. -from 2:32 to 2:34 pm, missing baseboard and water stained baseboards and siding in one of the residents' room. Mildew in the common bathroom. -at 2:40 pm, resident R1's bed has half bed rails but no doctor's order on file -at 3:00 pm, facility does not have telephone service and does not conduct disaster drill. -at 4:00 to 4:30 pm staff (S3, S4 and S5) do not have First Aid certificate and no 40 hours required training, 10 hours on the job training and medication training on file. S5 does not have LIC501 Personnel record. S4 and S5 do not have LIC503 Health Screening record on file. -at 6:30 pm, resident (R1) has doctor's order for 3 medications but the facility does have them. Administrator to submitted the following updated/current documents on this day: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $300.00 civil penalty is assessed for deficiency section 87355(e)(1) for staff who is not fingerprinted, and will continue for $100.00/day until corrected. Failure to submit proof of corrections by plan of correction due dates for other deficiencies may result in additional civil penalties. Deficiencies, plan and proof of corrections, and civil penalty were discussed with the administrator, Exit interview conducted. Appeal Rights, LIC421IM, LIC9098 Proof of Correction form and copy of this report provided.