Routine inspection·October 29, 2024

On 10/29/2024 at 9:50am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with Merla Fernandez, Caregiver, and explained the purpose of the visit. Administrator, Edwin Liwanag, arrived at 10:15am. The facility’s fire clearance was approved for eight (8) non-ambulatory and two (2) bedridden residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of seven (7) bedrooms and three (3) bathrooms. One (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. No bodies of water observed. A comfortable temperature is maintained at 69 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 120.0 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 09/16/2022. Emergency Disaster Plan was last posted on 10/3/2023. First aid kit was observed to be complete. Fire drill was last conducted on 10/3/2023. Continued on LIC809. Continued from LIC809. LPA reviewed four (4) staff and observed three (3) of four (4) files were current and complete. All five (5) resident files were reviewed current and complete. LPA reviewed a sample of medications. LPA observed the following deficiencies: At 10:10am, LPA observed during record review R1 did not have a hospice care plan. At 10:30am, LPA observed during record review S4 personnel file was incomplete. At 10:55am, LPA observed fire extinguisher was last serviced on 9/16/2022. At 10:55am, LPA observed mice droppings in kitchen drawer and a large rat trap in garage. At 10:55am, LPA observed milk of magnesia, mucinex, and Tussin in the refrigerator unlocked. At 11:50am, LPA observed facility did not have working smoke detectors. At 11:55am, LPA observed during record review facility has not conducted a fire drill. LPA requested the following documents to be submitted to CCLD by 11/5/2024. LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance Continued on LIC809C. Continued from LIC809C. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights and this report and appeal rights provided.