Routine inspection·September 21, 2023

On 09/21/2023 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Myra Ecaruan and explained the purpose of the visit. Acting Administrator, Joy Dela Cueva, arrived shortly after. Joy's Administrator Certificate# 6016749740 Expires 06/25/2024. The facility’s fire clearance was approved for 6 non-ambulatory. LPA toured facility with Joy including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 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 72 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 106.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 06/11/2023. Emergency Disaster Plan was last posted on 09/10/23. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 09/10/23. LIC809-C Continued... LIC809 Continued.... LPA reviewed 4 residents records. LPA reviewed 7 staff records and 0 of 7 have current first aid training and associated to the facility. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 11:24AM, LPA observed knives, scissors and matches unlocked in kitchen drawer. At 11:39 AM, LPA observed ladder, wood planks, garbage can located outside in the backyard At 11:43 AM, LPA observed screen door, more wood, broken wooded fence located behind storage shed in the backyard. At 11:45 AM, LPA observed wood planks in the front yard. At 11:48AM, LPA observed metal bed frames, walker, headboard, white door and dried up paint bucket located outside in front of the garage. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 09/28/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate 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.