Routine inspection·July 19, 2024

On 07/19/2024 at 11:13AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived to conduct an unannounced 1-Year Required inspection. LPA was greeted by Maricar Michellin. LPA met with Caregiver Gina Manlo who spoke with Administrator, Liezyl Ajos via telephone, and explained the purpose of the visit. The Administrator arrived at 11:43AM. Administrator currently holds a certificate (#7019104740) that expires on 12/01/2025. Facility has census of 3. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA observed a Maricar Michellin preparing food and Two (2) residents eating at the kitchen table upon entry. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of four (4) bedrooms and two (2) bathrooms. All outdoor and indoor passageways are kept free of obstruction. LPA did not observe any bodies of water. A comfortable temperature is maintained at 85 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 116.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/11/2023. Emergency Disaster Plan was last posted on 12/25/2023. First aid kit was observed to be complete. Fire drill was last conducted on 12/11/2023. Continued LIC809C. Continued from LIC809. Three (3) staff records were reviewed. During record review one (1) staff did not have Health Screening LPA reviewed all Three (3) resident records, During record review all three(3) residents didn't have Appraisal Needs and Service Plans LPA requested updated copies of the following documents to be submitted to CCLD by 07/26/2024 . · 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 LPA observed the following deficiencies: · At 11:20AM, LPA observed house guest preparing food in the kitchen. (S1) advised LPA of house guest not being associated or fingerprinted and that she's only visiting from another country · At 12:05PM, LPA observed unlocked closet with laundry detergent inside · At 12:11PM, LPA observed unlocked drawer with scissors Continue on LIC809C continued from LIC809C · At 12:12PM LPA observed Refrigerator door handle was broken · At 1:28PM LPA observed during record review that all three (3) residents were missing Appraisal Needs and Service Plans · At 1:56PM LPA observed during record review that (S3) did not have health screening · At 2:05PM LPA observed roaches crawling on counter top near fruit basket * The total amount of civil penalties assessed on today's date is $100.00 for volunteer not being associated or finger print cleared. * Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights, LIC421BG, and the report provided.