Routine inspection·January 2, 2025

On 01/26/2024 at 10:15AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator, Liezyl Ajos and explained the purpose of the visit. Administrator currently holds certificate #7019104740 Expires:12/10/2025. The facility’s fire clearance was approved for 6 non-ambulatory residents. LPA toured facility with Liezyl including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of six (6) total bedrooms which four (4) bedrooms are occupied by the residents and two (2) bedrooms are occupied by staff. Staff occupy the bedrooms upstairs; upstairs is not accessible to residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 71 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 115.0 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 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 were in operating condition during visit. Fire extinguisher was last serviced on 10/13/2023. Emergency Disaster Plan was last posted on 10/11/2024. First aid kit was observed to be complete. Fire drill was last conducted on 10/11/2024. Continue on LIC809C Continued from LIC809 LPA reviewed six (6) residents records. LPA reviewed three (3) staff records and (3) of (3) have current first aid training and associated to the facility. LPA requested the following documents to be submitted to CCLD by 01/09/2024 . · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan (last page) · Liability Insurance LPA observed the following deficiency: At 12:46PM LPA observed during record review two (2) out of three (3) staff members didn't have the yearly eight (8) hours of in-service training documented in files.. The following deficiency were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiency by POC date and/or any repeat deficiencies within a 12-month period may result in additional Civil Penalties. Exit interview conducted and a copy of this report and appeal rights provided.