Routine inspection·April 14, 2023

On 4/14/2023 at 12:30 PM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator, Crystal Vaka and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPA toured facility with Crystal including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. LPA observed locked gate around pool. A comfortable temperature is maintained at 74 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 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 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 detector were in operating condition during visit. Fire extinguisher was purchased on 9/25/2022. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 03/22/20223. Report continues on 809 C. At 12:45 PM LPA reviewed 4 residents records. At 1:10 PM LPA reviewed 4 staff records and 4 of 4 have current first aid training and associated to the facility. At 2:40 PM, LPA reviewed a sample of 3 resident’s medications. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: -At approximately 1:06 PM LPA observed resident files were incomplete. Resident 1 R1), R2 and R3 files are missing LIC 601, and LIC 603A. LPA observed R4 file to be empty, Administrator stated that their file was still at their previous facility and has not been brought to this facility. The following deficiency was 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. Exit interview conducted. Appeal Rights and a copy of this report provided. .