Routine inspection·November 30, 2023

At 10:35 AM Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct a 1-Year Annual Required visit and met with caregiver, Emelia Domingo. Administrator, Erlinda Gines arrived at approximately 11:00AM. The facility staffs all had criminal record clearances to work at the facility. LPA toured and inspected the facility inside and outside with administrator including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of seven (7) total bedrooms which five (5) bedrooms are occupied by the residents and one (1) bedroom is occupied by staff. The facility has auditory signals on each sliding door in the resident's room. All outdoor and indoor passageways are kept free of obstruction. There were no bodies of water present at this facility. LPA observed medication located in Kitchen and were observed to be locked. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the residents’ shared bathroom was measured at 118.1 degrees F. Resident's bathrooms have grab bars inside the shower. The showers have non-skid mat. Hygiene items, extra linens and toiletry supplies were checked and sufficient. Fire extinguisher in kitchen was last serviced on 4/18/2023 , smoke detectors and carbon monoxide were operational. First aid kit was inspected and was complete. Food supplies were sufficient to meet 2-day perishable and 7-day non-perishable requirements. Resident records were reviewed at approximately 11:15AM . Staff records were reviewed at approximately 12:00 PM. The following deficiencies were observed; · At approximately 12:10pm during staff file review LPA observed S1, S2, S3, S4 did not have current First Aid certification. · At approximately 12:20pm during staff file review LPA observed S5 is not associated to facility. · At approximately 12:30pm during staff file review LPA observed Administrator file incomplete missing Physicians report, TB screen, and Criminal record statement. Continued from LIC809 The following forms are to be updated and submitted to CCLD by 12/11/2023. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (9 pages) Liability Insurance Updated Facility floor plan/ Sketch 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. Exit interview conducted, a copy of this report provided and appeal rights provided