Routine inspection·January 30, 2024

On 01/30/2024 at 9:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator, Jamie Bernardino-Ruiz and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory. LPA toured facility with Jamie including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which all 6 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 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 at 107.3 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 detectors were in operating condition during visit. Fire extinguisher was last serviced 7/19/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 12/08/2023 . Emergency disaster plan updated 7/15/2023. At 9:30 AM, LPA reviewed 5 residents records. At 10:04 AM, LPA reviewed 5 staff records 5 of 5 are associated to the facility. At 11:00 AM, LPA reviewed a sample of resident’s medications. Continues to 809 C The following Deficiencies were Observed during Visit During File review LPA observed that R5's physician report states that they are bedridden and not on Hospice. Facility is not cleared for bedridden. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 02/13/2024: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Updated Facility Sketch Updated Fire Clearance 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. Exit interview conducted. Appeal Rights and a copy of this report provided.