Routine inspection·February 15, 2024

On 02/15/2024 at 10:00AM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Licensees/Administrator, Leonardo and Florida Alcantara, Jr. and explained the purpose of the visit. The facility’s fire clearance was approved for capacity of 6 (six) residents. All may be non-ambulatory. Hospice waiver for 1 (one). Administrator Certificate #6037095740 expired 10/04/2023. LPA toured facility with Leonardo including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 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 73 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 bathrooms was measured at 113.5 and 108.0 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 12/05/2023. First aid kit was observed to be complete. LIC809 Continued... LIC809-C Continued... LPA reviewed 2 residents records. LPA reviewed 2 staff records and 2 of 2 have current first aid training and associated to the facility. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:46AM LPA observed door screen and plywood located outside side backyard. At 10:47AM LPA observed wheelchair and toilet camode located outside backyard. At 10:48AM LPA observed 2 ladders, stove, screen door and tiles located outside at side backyard. 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. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 02/22/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Exit interview conducted. Appeal Rights and a copy of this report provided.