Routine inspection·October 4, 2023

On 10/4/2023 at 10:15am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-Year Required inspection. LPA met with Mary Burgess-Shaw, Caregiver, and explained the purpose of the visit. Rose Onyeagocha, Administrator, arrived at 11:08am. The facility’s fire clearance was approved for five (5) non-ambulatory and one (1) bedridden residents. LPA toured the facility with Caregiver including but not limited to bedrooms, bathrooms, kitchen, common area, garage and back yard. The facility consists of six (6) and three (3) bathrooms. 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 116.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/20/2022. Emergency Disaster Plan was last posted on 10/10/2019. LPA reviewed four (4) staff files and three (3) of four were incomplete. LPA reviewed all four (4) resident files and all were incomplete. Continued on LIC809C. Continued from LIC809. LPA observed the following deficiencies: At 10:25am, LPA observed S2 was fingerprinted or associated to the facility. At 10:35am, LPA observed facility does not have a 7-days of non-perishables and 2-days perishables available for residents. At 10:40am, LPA observed during record review there is not a doctor's order for a hospital bed for R1. At 10:50am, LPA observed a chest of drawers, 2 wheelchairs, a walker, a step ladder, and a bedframe in back yard.. At 11:15am, LPA observed during record review that resident records were incomplete. At 11:30am, LPA observed during record review that staff records were incomplete. At 11:30am, LPA observed during record review three (3) of the four (4) staff records does not contain a first aid certification. At 11:30am, LPA observed during record review that staff does not have any training records. LPA requested the following documents to be submitted to CCLD by 10/11/2023. Resident Roster LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (9 pages) Liability Insurance Continued on LIC809C. Continued from LIC809C. 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. *An immediate $500.00 civil penalty will be assessed on today's date for association.* Exit interview conducted. A copy of the LIC421BG, this report and appeal rights provided.