Routine inspection·July 19, 2023

On this day, July 19, 2023, at 1:00 p.m, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual inspection. LPA was granted entry by House Manager Sally Espina. LPA met with Haidie Bautista, administrator, and informed the reason for visit. Facility has LIC9282 Infection Control Plan. LPA toured the facility inside out with the administrator. LPA inspected the 2 buildings (Bldg A and Bldg B) including but not limited to common areas, kitchen, dining areas, receiving room, library in Bldg B, bathrooms, shower room, toilets and yard. LPA selected 3 and 2 residents rooms in Bldg A and Bldg B respectively for inspection. Fire extinguishers were observed fully charge with tags showed serviced March 16. 2023. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications and medication carts were locked. Cabinets/drawers for knives were locked. All residents rooms, dining and common areas were equipped with electric fans. Hallways, common areas, porch were observed free of hazards. Facility has smoke and carbon monoxide detectors that were observed functional. Hot water temperature in bathrooms in Bldg A and Bldg B were tested, and measured at 108.7 and 115 degrees Fahrenheit respectively. Facility conducts disaster drills, and records showed last conducted April 1, 2023. LPA reviewed 5 residents and 5 staff files, and interviewed 3 staff and 3 residents. Medications were checked and compared with records. Facility does not handle residents' cash resources. .......continued on 809C LPA observed the following: -at 5:05 pm residents (R1, R2. R3, R4 and R5) Appraisal on file were over a year old. -at 5:15 pm, resident's (R4) LIC602A indicated dependent on others with all activities of daily living; however. R4 can feed self. LIC602A is over a year old. LPA received the following updated documents on this same day: 1. LIC308 Designation of Facility Responsibility 2. LIC610E Emergency Disaster Plan (9 pages) 3. Proof of $3M liability insurance coverage Administrator to submit copy of updated LIC500 Personnel Report by 8/02/23. 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.