Routine inspection·October 24, 2024

On this day, October 24, 2024, at 1:15 p.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual inspection. LPA met with House Manager Sally Espina and Haidie Bautista, administrator, and informed the reason for visit. LPA started the inspection with house manager and continued with administrator. LPA inspected the 2 buildings (Bldg A and Bldg B) including but not limited to common areas, kitchens, dining areas, receiving room, library, bathrooms, shower rooms, toilets, front, side and backyard. LPA selected for inspection 4 residents rooms in Bldg B and 7 in Buiding A. Fire extinguishers were observed fully charge with tags showed serviced May 21, 2024. 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. All residents rooms, dining and common areas were equipped with electric fans. Hallways, common areas, yards and porch were observed free of hazards. Facility has smoke and carbon monoxide detectors that were observed functional. Hot water temperature in one of the bathrooms in Bldg A was tested and measured at 118.4 degrees Fahrenheit . Facility conducts disaster drills every quarter and records showed last conducted October 14, 2024. LPA reviewed 5 residents and 5 staff files, and interviewed 4 residents. Medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Facility does not handle residents' cash resources. .......continued on 809C LPA observed the following: -at 1:30 p.m., greasy cooking range and grease deposits in the corner of flooring in the kitchen in Bldg A. -at 1:38 p.m., vinyl flooring tiles in Bldg B coming off. -at 1:40 p.m., mildew in the shower and broken faucet in Bldg B. -at 1:56 p.m., chipped electrical outlet plate in one of the resident's rooms in Bldg A. -at 5:15 p.m., resident's (R1) medications filled on 10/02/24 & 10/21/24 has no LIC622. R1 has doctor's order for Ferrous Sulfate but facility does not have this medication. -at 5:50 p.m., staff crossed-out one of resident's (R2) medications on the label. LPA received updated copies of the following documents: 1. LIC308 Designation of Facility Responsibility 2. LIC610E Emergency Disaster Plan 3. LIC9282 Infection Control Plan 4. $3M liability insurance certificate Administrator to submit a copy of updated LIC500 Personnel Report by 11/07/24. 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.