Routine inspection·May 3, 2023

On 05/03/2023 starting 1:09 PM, Licensing Program Analyst (LPAs) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Licensee, Lilia Perdiguerra and explained the purpose of the visit. The facility’s fire clearance was approved for all six (6) non-ambulatory residents. There were 2 staff and 4 residents present during inspection. Starting at 1:20 PM, LPA toured facility with Licensee and Administrator, Jerry Perdiguerra including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 bedrooms are for residents and 1 bedroom is for 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 residents’ shared bathroom was measured at 110.8 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. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 10/13/2022. First aid kit was observed to be complete. REPORT CONTINUES ON LIC809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 1:20 PM, LPA observed medication pill bottle located in kitchen cabinet vitamins At 1:21 PM, LPA observed multi surface cleaner spray, Raid Ant Spray, kitchen degreaser located under sink At 1:22 PM, LPA observed scissors, knives and other sharps located in kitchen cabinet At 1:24 PM, LPA observed disinfectant spray and Clorox Wipes located in Bedroom# 2 bathroom under sink At 1:27 PM, LPA observed disinfectant spray, Tide Liquid Laundry Detergent, Clorox Bleach in cabinets in laundry area At 2:30 PM, LPA observed that R1 in Bedroom# 1 has oxygen sign on door, but no "Oxygen in Use" posted on the front door outside At 2:35 PM, LPA observed shovel, wheel barrel, ladders located in backyard unlocked At 2:37 PM, LPA observed tools: hammers, saws, gardening tools in shed unlocked At 2:50 PM, LPA observed during record review that R4 who is bedridden in Bedroom#3 has no Fire Clearance At 3:16 PM, LPA observed no staff records available during record review 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. LPA will return at a later time to complete the inspection. Exit interview conducted. Appeal Rights and a copy of this report provided.