Routine inspection·October 12, 2023

On 11:25AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiv er, Marita Sablay the purpose of the visit. Jose Michael Torio arrived approx. 30mins later. Jose's Administrator Certificate# 6033028740 Expires 10/22/24. The facility’s fire clearance was approved for 6 residents Non-Ambulatory and 1 Bedridden in Rm# 6 only. LPA toured facility with Jose including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. There are no bodies of water observed. 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 108.3, 109, 109.5 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 and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 04/04/2023. Emergency Disaster Plan was last posted in 2019. First aid kit was observed to be complete. Emergency disaster drill was last conducted on . At 12:17PM, LPA reviewed 6 residents records. At 3:13PM, LPA reviewed 7 staff records and 6 of 7 have current first aid training and associated to the facility. LIC809C Continued... LIC809 Continued.... THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 11:40 AM LPA observed scissors unlocked underneath sink cabinet At 12:10 PM LPA observed washing machine, boxes on outside garage At 12:11 PM LPA observed empty laundry detergent buckets behind shed At 12:12 PM LPA observed pot, spoon, green screen door, wood, debris behind outside shed 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 Penaltieties Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/19/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Updated facility sketch Exit interview conducted. Appeal Rights and a copy of this report provided.