Routine inspection·June 28, 2024

On 06/28/2024 around 03:00 PM, Licensing Program Analyst (LPA) L. Holmes arrived announced to conduct a required annual inspection. LPA contacted Maria Riformo (ADM) and explained the purpose of the visit; the facility previously had zero (0) clients. Licensee currently holds a standard certificate (#6006016740 ) exp. 04/06/2025. The facility’s fire clearance was approved for six (6), no more than four (4) non-ambulatory residents and one (1) bedridden; census is two (2). LPA and ADM toured the facility including, but not limited to common areas, bathroom, bedrooms, kitchen, and backyard. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. All hand washing stations were equipped with soap, paper towels and covered garbage cans. There was a surplus of PPE centrally located inside the facility that is accessible to all care staff. Hot water temperature in the shared residents' bathroom was measured at 114.7 degrees Fahrenheit (F) and the facility's temperature was comfortable at 74 degrees Fahrenheit (F). Fire extinguisher was observed full. Smoke detectors were observed operational and first aid kit complete. Continued on LIC809C... ...continued from LIC809. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct these deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalties. LPA observed the following deficiencies during course of inspection : At 3:45 PM – LPA observed a bedrail and absence of a doctor’s order in resident’s (R2) file. At 4:00 PM – LPA observed absence of carbon monoxide detectors and expired fire extinguisher. At 4:35 PM – LPA observed absence of staff’s training records, first aid and CPR certification. At 5:00 PM – LPA observed resident (R1) at the facility. Licensee stated that R2 visits and stays at the facility sometimes. R1 does not have an admission agreement. The following forms are to be updated and submitted to CCLD on or before 07/12/24: -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610D Emergency Disaster Plan -Certificate of Liability Insurance Exit interview conducted, appeal rights and a copy of this report provided to Licensee, Maria Riformo.