Routine inspection·April 18, 2023

On 4/18/2023 at 3:05PM, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-Year Required inspection. LPA met with Direct Support Professional, Florin Jervoso and explained the purpose of the visit. The Administrator currently holds a certificate (#6017788740) that expires on 06/19/2024. The facility’s fire clearance was approved for six (6) non-ambulatory and 1 bedridden resident. 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) total bedrooms and two (2) bathrooms, which three (3) bedrooms are occupied by the residents and one (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 70 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 104.9 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/ carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 04/04/2022. Emergency Disaster Plan was last posted on 5/16/2022. First aid kit was observed to be complete. Fire drill was last conducted on 05/16/2022. Continued on LIC809. Continued from LIC809. Three (3) staff records were reviewed, and all staff have criminal record clearance and holds a current first aid and CPR certificate. All five (5) Clients records were reviewed. LPA observed the following deficiencies: At 4:10PM, LPA observed appraisal needs and service plan for all residents were not current. LPA requested the following documents to be submitted to CCLD by 4/25/2023. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in Civil Penalties. Exit interview conducted. A copy of appeal rights and this report provided.