Routine inspection·November 30, 2023

On 11/30/2023 at 9:45 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregivers, Dominador Lampano and Nina Alapar and explained the purpose of the visit. Nina phoned the Administrator, Leah MacDonald and advised. Leah arrived approximately 30 minutes later. Administrator's Certificate# 6015445740 Expires 05/11/2024. The facility’s fire clearance was approved for six (6) capacity in which all may be non-ambulatory with a hospice waiver for two (2). LPA toured facility with Nina including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 5 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 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 bathroom was measured at 113 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. LIC809-C Continued... LIC 809 Continued... Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 03/06/2023. Emergency Disaster Plan was last posted on 11/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 10/01/2023. LPA reviewed 5 residents records. LPA reviewed 4 staff records and 3 of 4 have current first aid training and associated to the facility. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:11 AM LPA observed a bottle of Clorox Bleach unlocked under the kitchen sink cabinet. At 10:45 AM LPA observed Resident #5 in a full rail hospital bed At 12:30 PM LPA observed during file review no doctor's orders for full rail hospital bed for Resident #5 At 1:30 PM LPA observed during file review that Staff #4 was missing Health Screening and TB Test. 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 12/07/2023: 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.