Routine inspection·December 5, 2024

On 12/05/2024 at 9:25 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregivers, Marilyn Magalued and Joanna Magalong and explained the purpose of the visit. Marilyn phoned the Licensee/Administrator, Leah MacDonald to inform. The facility’s fire clearance was approved for capacity of six (6) all non-ambulatory residents. Hospice waiver approved for two (2) residents. Administrator Certificate # 7004457740 expires 05/11/2024. LPA toured facility with Joanna including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of five (5) total bedrooms which four (4) bedrooms are occupied by the residents and one (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 76 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 129.2 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 03/01/2024. Emergency Disaster Plan was last posted in 2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 10/01/2024. LIC809-C Continued... LIC809-C (Page 2) LPA reviewed four (4) residents records. LPA reviewed four (4) staff records and four (4) of four (4) have current first aid training and associated to the facility. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 12:15pm, LPA observed the hot water temp. was measuring 129.2 in shared bathrooms. At 12:31pm, LPA observed range stove located outside in the 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 12/12/2024: 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.