Routine inspection·September 4, 2024

On 09/04/2024 at 1:20PM, Licensing Program Analysts (LPAs) T. Syess-Gibson and David Doidge conducted an unannounced 1-Year Required inspection. LPAs met with Caregiver Irma Martinez, spoke with Administrator, Paul Lem via telephone, and explained the purpose of the visit. The Administrator arrived at 2:00PM. LPAs observed via CCL website that Administrator Certificate is currently in pending status. Facility has census of 4. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPAs toured the facility with Caregiver, Irma Martinez including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of seven (7) bedrooms, three (3) bathrooms with One (1) bedroom being occupied by staff .All outdoor and indoor passageways are kept free of obstruction. LPAs did not observe any bodies of water. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPAs 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 110.0 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and skid mats. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/19/2024. Emergency Disaster Plan was last posted on 08/21/2024. First aid kit was observed to be complete. Fire drill was last conducted on 08/01/2024. Continued LIC809C. Continued from LIC809 LPAs reviewed Four (4) staff records and all four (4) resident records, residents records were current and complete. LPAs also reviewed medications During visit LPAs observed the following deficiencies: At 1:44PM LPAs observed there wasn't a minimum of 7-day supply of non-perishable and 2-day of perishable food for residents in care At 2:24PM LPAs observed during record review S2, S3 and S4 were all missing Health Screening documents At 3:17PM during medication review LPAs observed medication in kitchen refrigerator unlocked. LPAs requested updated copies of the following documents to be submitted to CCLD by 09/11/2024. · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan · Liability Insurance · Current Administrator’s Certificate (upon arrival) Exit interview conducted and a copy of this report provided.