Routine inspection·October 9, 2024

On 10/09/24 at 01:45 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required annual inspection. LPA was greeted by one staff upon entry and explained the purpose of the visit. The Administrator, Norma Tejero (ADM) holds a standard certificate (#6047865740) . The facility’s fire clearance was approved for a capacity of seventy (70) all may be non-ambulatory residents. LPA observed a screening station at the entry that contained a thermometer, hand sanitizer, masks, COVID-19 signage, and a visitor sign-in log; There is a surplus of face shields, gowns, gloves and other PPE centrally stored inside the facility that is accessible to all care staff. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. LPA toured the facility including but not limited to common areas, bathrooms, kitchen, front and backyard. Medication and sharps were locked, and there was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap, paper towels and garbage cans. Hot water temperature in the shared residents' bathroom was measured at 98 Fahrenheit (F.) and the facility's temperature was 69 degrees F. First aid kit complete. Seven (7) staff and six (6) resident files were reviewed: Resident files need auditing for dates and signatures on Medical Consent forms, the LIC613 and Admission Agreements. The following forms are to be updated and submitted to CCLD: 10/23/24 -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility (Reviewed) -LIC610 Emergency Disaster Plan (Reviewed) -An updated copy of Administrator Certificate (Reviewed) -Pest Control Report for July - September 2024 Continued on LIC809C... ...continued from LIC809. -At around 1:50 PM, LPA observed exit gate and drive thru gate on the right side of building both having pad locks. On the gate of the left side; the pad lock was in place and unlocked at 3:45 PM. -At around 1:52 PM, LPA observed 2-3 black bed frames, a twin sized mattress, and several various sizes of wooden boards on right side of building. -At around 1:55 PM, LPA observed two (2) windows without screens and two (2) windows screens that had tears and was in disrepair located on the front side of building. LPA observed One (1) window without a screen and two (2) windows screens that had tears and was in disrepair located on the back side of building at 3:15 PM -At around 2:43 PM, the water in two separate shared residents' sinks measures at 91 and 98 degrees Farenheit (F.) -At around 2:50 PM, downstairs bathroom had mildew on the shower curtain, rust stains on the shower floor and around the door perimeter, and three (3)clothes were observed on the floor covering the bottom gaps of the doors. (photos taken) -At around 3:15 PM, LPA observed 5-6 PVC white tubing, 2-3 wooden pallets on the back side of the facility, 2-3 metal or silver colored strips of material about 10 x 2 feet wide under the gazebo, a tote page with worn looking clothes and plastic garage bags, several wooden boards of various sizes, a gray metal frame similar to the size of a standard coffee table. -At around 3:50 PM, Two (2) sitting chairs in the hallway were stained with dark colored spots all over the seat. Room #35, dresser has dark smudge prints and floor has small random particles. -At around 5:04 PM, LPA observed that proof of ADM's 1st aid and CPR was missing from the staff file. (corrected during visit) -At around 5:07 PM, ADM could not provide proof of liability insurance. (licensee corrected during visit) Continued on LIC809C... ...continued from LIC809C. Deficiencies observed (see LIC809D) and cited from the California Code of Regulations. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. -An immediate $500.00 civil penalty will be assessed on today's date for the emergency exit being locked.* Exit interview conducted, a copy of the LIC421IM, appeal rights and the report provided to Norma Tejedo, ADM. Physical Plant/Environmental Safety - Row13 - Maintenance and Operation Section 87303(e)(2) - Domain Focused (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).