Routine inspection·October 16, 2024

On 10/16/2024 at 8:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with House Manager, Jet Siador and explained the purpose of the visit. LPA spoke with Administrator over the phone and they approved Jet to conduct the visit. The facility’s fire clearance was approved for 6 non-ambulatory and a hospice waiver for 2. LPA toured facility with Jet including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which all 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 71 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 105.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 11/13/2023. Emergency Disaster Plan was last posted on 10/16/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 10/01/2024. At 10:50am, LPA reviewed 6 residents records. At 11:20 am, LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. Report Continues on LIC809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:40am LPA observed that Kitchen oven is broken and has a sign stating "DO NOT TOUCH BROKEN"* At 9:42am LPA observed 2 knives, 2 scissors, and one lighter unlocked and accessible to residents in the kitchen in the drawer by the fridge* At 9:43am LPA observed moldy bell peppers, slimy celery, and slimy broccoli in the refrigerator. Food was also improperly covered and stored in the refrigerator.* At 9:53am LPA observed a roll away bed in the common area living room. LPA asked who uses the bed and if anyone sleeps in the living room to which the House Manager replied that Night Staff use it and also sometimes sleep on the couch. LPA also observed staffs personal toiletries on side of the couch.* At 9:58am LPA observed that room 4 had oxygen but that the required oxygen in use sign was not posted.* At 9:59am LPA observed that the walkway to access the sink was blocked in room 5 by mattress and hoyer lift.* At 10:00am LPA observed that the shower did not have a non-slip mat. Later LPA observed that the other shower also did not have a mat but rather a wet bath towel on the floor.* At 10:01am LPA observed that the tile in front of room 5's shower is cracked and able to lift up. The baseboards were also observed with water damage* At 10:04am and throughout visit LPA observed a thick coating of dust and cobwebs on air vents, fans, behind refrigerator and in corners of walls by the ceiling and by floor area* At 10:08am LPA observed a rat trap in room 1. when LPA went to look for signs of vermin they found under the kitchen sink rat feces, and a dead mouse.* At 10:11am LPA observed a broken/ cracked outlet cover in room 3. Also a hole in the wall behind bedroom door measuring about 4 inches. The kitchen also had a similar hole, peeling paint, and rips in dining chairs.* At 10:25am LPA observed a pile of boxes blocking the walkway, as well as mattresses and other items improperly stored outside.* 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. Exit interview conducted. Appeal Rights and a copy of this report provided.