Routine inspection·September 21, 2023

On 09/21/2023 at 2:30PM, Licensing Program Analysts (LPAs) L. Hall and A Gomez conducted an unannounced 1-Year Required inspection. LPA met with caretaker, George Estrella, and explained the purpose of the visit. The administrator, Marivel Calambro arrived at 1:55PM. 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) total bedrooms which five (5) bedrooms are occupied by the residents and one (1) bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 77 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. 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 09/11/2023. Emergency Disaster Plan was last posted on 09/06/2019. First aid kit was observed to be complete. Fire drill was last conducted on 09/13/2023. Continued on LIC809. Continued from LIC809. Three (3) staff records were reviewed, and all staff have criminal record clearance and holds a current first aid certificate. All six (6) Clients records were reviewed and were incomplete. LPA observed the following deficiencies: At 1:37PM, LPAs observed hook latch lock on front door. At 2:05PM, LPAs observed R1 and R2 does not have a doctor's order for their hospital bed. At 2:15PM, LPAs observed during report review that staff does not have current training. At 2:30PM, LPAs observed during record review that all six (6) resident files were incomplete. LPA requested the following documents to be submitted to CCLD by 9/28/2023. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Resident Roster 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 appeal rights and this report provided.