Routine inspection·December 11, 2024

On 12/11/2024 at 3:00pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with Noupane Temple, Licensee, and explained the purpose of the visit. Administrator holds a certificate #6065439740 expires 1/22/2025. Administrator, Rachel Laine, arrived at 4:10pm. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of five (5) bedrooms and three (3) bathrooms. No bodies of water was 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 147.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 09/09/2024. First aid kit was observed to be complete. LPA reviewed four (4) staff records and six (6) resident records. LPA also reviewed medications. Continued on LIC809. Continued from LIC809. LPA observed the following deficiencies: At 3:15pm, LPA observed unlocked cabinet underneath kitchen sink containing knives and soft scrub. At 3:20pm, LPA observed R1 and R4 resides in ambulatory room only. At 3:25pm, LPA observed Pine-Sol in unlocked bathroom cabinet in room #1. Lysol spray sitting on dresser in room #1 and on table in living room. At 3:35pm, LPA observed R4, R5, and R6 all have hospital beds with rails and without a doctor's order. At 3:45pm, LPA observed hot water in residents' shared bathroom was 147.3 degrees F. At 4:00pm, LPA observed during record review none of the residents have an appraisal needs and services plan. At 5:00pm, LPA observed during record review medication administrative records (MAR) were not accurate. Medications were missing from (MAR), MAR didn't show medication was taken, and medication was not in it's original bottle. LPA requested the following documents to be submitted to CCLD by 12/18/2024. LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (9 pages) Liability Insurance Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Exit interview conducted. A copy of appeal rights and this report provided.