Routine inspection·June 8, 2023

On 06/08/2023 at 3:43 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Catalina Atienza and explained the purpose of the visit. LPA spoke with the Licensee/Administrator Conchita Gozun who was out at a doctor's appointment with one of the resident. The facility’s fire clearance was approved for 6 where 5 may be non-ambulatory. LPA toured facility with Catalina including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 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 74 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 109.5 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 detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 08/15/2022. Emergency Disaster Plan was last posted 07/02/2021. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 05/18/2023. LPA reviewed 1 residents records. LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. LIC 809-C Continued... 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 3:50 PM LPA observed scissors unlocked and keys hanging in the kitchen At 3:55 PM LPA observed 2 wheelchairs, floor lamp, portable toilet camode, wood table set with 4 chairs, bike, ice chest cooler, bag of plastic bottles, 45 watt solar panel kit box, cardboard boxes and a radio boom box located outside back yard At 4:15 PM LPA observed during resident record review that there was only 1 resident file available for review. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 06/15/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Exit interview conducted. Appeal Rights and a copy of this report provided