Routine inspection·January 4, 2024

On 1/4/2024 at 1:30PM, Licensing Program Analysts (LPAs) L. Hall and T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPAs met with Caregiver Salazar, spoke with Administrator, Tatyana Buynevich via telephone, and explained the purpose of the visit. The Administrator currently holds a certificate (#6033319740) that expires on 01/4/2025. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) bathrooms. All outdoor and indoor passageways are kept free of obstruction. LPA did not observe any bodies of water. A comfortable temperature is maintained at 68 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 118.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 09/08/2023. Emergency Disaster Plan was last posted on 11/18/2023. First aid kit was observed to be complete. Fire drill was last conducted on 03/16/2022. Continued on LIC809C. Continued from LIC809. Four (4) staff records were reviewed. During record review one (1) staff was not associated to facility and did not have a health screening. LPA reviewed all five (5) resident records and they were current and complete. LPA requested the following documents to be submitted to CCLD by 1/11/2024. 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 deficiencies: At 1:35pm, LPAs observed an additional lock on front door to stop residents from exiting. At 2:40pm, LPAs observed during record review S4 did not have a health screening and was not associated to the facility. * The total amount of civil penalties assessed on today's date is $500.00 for staff not being associated.* Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. 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 the appeal rights, LIC421BG, and the report provided.