Routine inspection·November 26, 2024

On 11/26/2024 around 09:00 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced for a required annual inspection. LPA met with Benita De Guzman, Caregiver (S1) and explained the purpose of the visit. The facility’s fire clearance was approved for eight (8) non-ambulatory residents; four (4) may be Hospice approved. Upon arrival, LPA observed one (1) staff attending to the residents and serving breakfast, and several residents visiting in the common area watching television. LPA toured the facility with S1. The areas included but were not limited to the common areas, dining room, bathrooms, kitchen, laundry room, office and backyard. The front yard and passageways were free of obstruction. A comfortable temperature was maintained at 72 degrees Fahrenheit (F). LPA observed lighting in all areas to be adequate for the comfort and safety of the residents. The hot water temperature in the shared restroom was measured at 113.6 degrees (F). The shared restroom had paper towels, soap and garbage cans; all areas were safe and sanitary. PPE, sanitizer, and paper goods remain sufficient. There was a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. ...continued on LIC9099C. ...continued from LIC9099. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was observed full and last serviced 12/29/23. Emergency Disaster Plan is updated; safety drills and training are rotational. LPA reviewed four (4) staff files, and five (5) resident files that were complete. -Around 09:37 AM, LPA witnessed 3 unlocked scissors on the cabinet mixed with pens and pencils in wooden holder; S1 corrected during visit. -Around 09:46 AM, LPA observed lysol cleaner, a can of air freshener, and clorox wipes unlocked in the hallway closet; S1 corrected during visit. -Around 09:50 AM, LPA observed R1's oxygen tank stored without it's stand in room #1; S1 corrected during visit. -Around 10:07 AM, there was a body of water present near the garage in the backyard where cement (approximately 10x10 ft. opening) had been poured due to the construction and rain but is inaccessible to residents. The following forms are to be updated and submitted to CCLD by 12/04/24 : -Resident Roster -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610 Emergency Disaster Plan (Reviewed) -Administrator's Standard Certificate Deficiencies are being cited on the attached LIC 809D. Failure to correct the deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided to OP and ED.