Routine inspection·January 5, 2024

On 01/05/2024 at 9:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. Upon arrival, LPA was greeted by Caregive r Pauline Fearon Mitchell . Licensee arrived at 10:00 AM. LPA met with Licensee, Mona Eweda and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPA toured facility with Mona including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 4 total bedrooms which 3 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 69 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 109.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 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 01/20/2023. Fir st aid kit was observed to be complete. Emergency disaster drill was last conducted on 12/10/2023. Report continues on LIC809-C At 12:00PM LPA reviewed 3 of 3 residents records. At 12:20 PM, LPA reviewed 3 staff records. ALl staff are associated to the facility. The following Deficiencies were observed: At 9:00AM When LPA arrived only one staff was on duty and staff does not posses the required training required by CCLD. At 12:30PM During file review LPA observed that there was no file for Pauline Fearon Mitchell and that all files were incomplete and missing documents for other staff (criminal record statement, LIC 501) At 1:30PM During file review LPA observed that no staff has valid first aid or CPR. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 01/19/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and Health and Safety Code. Failure to correct deficiencies by POC date may result in Civil Penalties. Exit interview conducted and a copy of this report provided. Appeal rights were provided.