Routine inspection·September 22, 2023

On 09/22/2023 at 12:02 PM, Licensing Program Analysts (LPAs) P. Watson and A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. Upon arrival LPAs were greeted by caregiver and explained the purpose of the visit. Administrator was unable to join the visit and allowed caregiver Analyn Bravante to sign report. The facility’s fire clearance was approved for 5 Non Ambulatory and 1 Bedridden . LPAs toured facility with caregivers including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which all 4 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 70 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 117 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day 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 detectors were in operating condition during visit. Fire extinguisher was last serviced on 05/18/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 07/10/2023. Report continues on 809 C. At 12:05 PM, LPA reviewed 3 of 3 residents records. At 12:20 PM, LPA reviewed 4 of 6 staff records and 4 of 4 have first aid training and associated to the facility. At 1:00 PM, LPA reviewed a sample of 3 of 3 resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/13/2023: 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 The following deficiency was observed during inspection: -At 1:02 PM LPAs were informed that caregivers perform glucose testing for R1. The following deficiencies were observed (see LIC 809 D) 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. Exit interview conducted and a copy of this report provided along with Appeal rights