Routine inspection·August 22, 2023

On 08/22/2023 at 2:50 PM, Licensing Program Analysts (LPAs) L. Alexander and L. Fontanilla arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Caregiver, Evaruth Olkerill and explained the purpose of the visit. The Co-Administrator, Laly Bascao arrived approx. 3:15 PM. The Licensee/Administrator, Terri Marsala, was not available. The facility’s fire clearance was approved for 9 non-ambulatory and a hospice waiver for two (2) residents. LPAs toured facility with Eva including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 9 total bedrooms which 8 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPAs 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 106.4 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. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 01/12/2023. Emergency Disaster Plan was last posted in 2019. First aid kit was observed to be complete. LIC 809C....Continued LIC 809 Continued.... LPAs reviewed 5 residents records. LPAs reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 3:20 PM LPAs observed during tour and record review that R4 was bedridden without proper bedridden fire clearance At 4:00 PM LPAs observed during tour and record review that R4 does not have doctor's order and approved exception on file for full rail hospital bed. 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. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by : 08/29/2023 LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Facility Sketch Current Administrator’s Certificate Exit interview conducted. Appeal Rights and a copy of this report provided.