Routine inspection·September 11, 2024

On 09/21/2023 at 2:30PM, Licensing Program Analyst (LPA) L. Hall conducted an unannounced annual required inspection. LPA met with caregiver, Elaine Francisco, and explained the purpose of the visit. The administrator, Marivel Calambro arrived at 2:00pm. The facility’s fire clearance was approved for five (5) non-ambulatory and one (1) bedridden 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. One (1) bedroom occupied by staff. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 73 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 102.2 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 08/29/2024. Emergency Disaster Plan was last posted on 08/14/2024. First aid kit was observed to be complete. Fire drill was last conducted on 07/20/2024. Continued on LIC809. Continued from LIC809. Four staff records were reviewed. LPA also reviewed all four (4) resident records which were incomplete. LPA observed the following deficiencies: At 1:45pm, LPA observed during record review LPA observed all four (4) resident files were incomplete. At 1:45pm, LPA observed during record review facility did not submit a hospice initiation notification for R1. At 1:45pm, LPA observed during record review that facility did not report R1's hospitalization. At 1:45pm, LPA observed R3 had a half-rail but facility does not have a doctor's order. At 2:15pm, LPA observed during record review S2 does not have a health screening. At 2:45pm, LPA observed facility have two (2) bedridden residents located in bedrooms 2 and 3. At 4:30pm, LPA observed during record review facility did not maintain a record of each dose in the resident's record. LPA requested the following documents to be submitted to CCLD by 9/18/2024. 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. *An immediate civil penalty of $750.00 will be assessed on today's day* 87202(a)(2) = $500.00 1x 87608(a)(3) = $250.00 for repeat 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.