Routine inspection·January 30, 2024

On 01/30/2024 at 1:30 PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with caregiver Alicia Fontela and explained the purpose of the visit. Administrator, SHAHID SIDDIQUI arrived at approximately 3:00pm and explained the purpose of the visit. The facility’s fire clearance was approved for 8 Non-Ambulatory. Hospice waiver approved for 4. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the clients and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 74 degree Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 125.2 degree Fahrenheit. All toilets, hand washing and bathing are safe, sanitary and in operating condition. The supply of extra hygienes were available for clients. There is a minimum of one week supply of nonperishables and 2-day perishables food supply. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 11/14/2023. First aid kit was observed to be complete. At 1:45pm, 5 of 6 clients records were reviewed. At 2:30pm, 4 staff records were reviewed and 4 of 4 have current first aid training and associated to the facility. Report Continues on LIC 809-C The following Deficiencies were observed during Visit During File review LPA observed that all resident files are incomplete and missing Emergency consent forms, Personal rights, Emergency ID's, and other forms At 4:00pm During Facility tour LPA observed Hot water temperature in residents shared bathroom measuring at 125.2 degrees F. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 01/13/2024: LIC 500 Personnel Report LIC 308 Designation of Administrative Responsibility LIC 610E Emergency Disaster Plan Updated Facility Sketch and Fire Clearence 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.