Routine inspection·November 14, 2024

On 11/14/2024 at 3:15 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Marjoy Bacuyag and explained the purpose of the visit. Marjoy called Administrator, Keith Mauer, to inform. The administrator arrived 15 mins later. The facility’s fire clearance was approved for capacity of six (6) in which all may be non-ambulatory. Hospice waiver approved for two (2) residents. Administrator Certificate #606274274 expired 08/09/2024. Administrator submit certificate renewal and provided check dated 11/07/2024. LPA toured facility with Keith including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of total six (6) bedrooms which six (6) bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 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 105 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguishers was last serviced on 02/08/2024. Emergency Disaster Plan was last posted on 01/08/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 08/28/2024. LIC809-C Continued (Next Page) LIC809-C Continued... LPA reviewed four (4) residents records. LPA reviewed five (5) staff records and 5 of 5 have current first aid training and associated to the facility. 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. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 3:32 PM LPA observed unlocked medications and scissors located in top kitchen drawer. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 11/21/2024: LIC 308 Designation of Administrative Responsibility - Reviewed LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance Exit interview conducted. Appeal Rights and a copy of this report provided.