Routine inspection·December 30, 2024

On 12/30/2024 at 9:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Backup Administrator, Ana Breen and explained the purpose of the visit. The facility’s fire clearance was approved for all may be non-ambulatory with a hospice waiver for 3. LPA toured facility with Ana including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 4 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 76 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 133.7 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 11/20/2024. Emergency Disaster Plan was last posted on 1/02/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted in September 2024. At 10:41am, LPA reviewed 4 residents records. At 11:00 am, LPA reviewed 3 staff records and 2 of 3 have current first aid training and associated to the facility. LPA reviewed a sample of resident’s medications. Report Continues on LIC809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:39AM LPA observed bags of trash in the backyard on the deck. At 9:41AM LPA observed expired canned goods. At 9:44AM LPA observed that food is improperly stored in fridge and freezer; open meat and uncovered residents food At 9:44AM LPA observed kitchen surfaces to be unclean and layered with grease and oils At 9:47AM LPA observed a Lighter in a drawer under the oven as well an unsecured butchers knife by the kitchen sink. At 9:48AM LPA observed cobwebs built up in the residents living room At 9:56AM LPA observed broken drawers throughout the facility off the tracks or missing handles At 9:57AM LPA observed unclean surfaces throughout the facility At 11:04AM LPA observed the hot water at 133.7 degrees F. ***Civil Penalty Assessed for repeat violations $250 X 2 Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 01/15/2025: LIC 308 Designation of Administrative Responsibility Updated Administrator Documents The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.