Routine inspection·May 1, 2024

On 05/01/2024 at 10:20 AM, Licensing Program Analyst (LPA) Carol Fowler arrived unannounced to conduct Required 1 Year Annual inspection. Upon arrival LPA was greeted by caregiver, Rizza Bantigue. LPA spoke to Sabrina Crowder, on the phone and explained the purpose of the visit. House Manager Monique Robinson will be joining the visit at approximately 1:00PM. The facility’s fire clearance was approved for 5 Non-Ambulatory and 1 Bedridden. LPA toured facility with 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 residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 68 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 bathrooms were measured 142.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 12/21/2023 . First aid kit was observed to be complete. Emergency disaster drill was last conducted on 06/14/2023 . Report continues on 809 C Continue from LIC 809 LPA reviewed 3 of 6 residents records. LPA reviewed 4 of 5 staff records and of 4 have first aid training and associated to the facility. LPA reviewed a sample of 6 of 6 resident’s medications. LPA observed the following deficiencies: · At 10:30am, LPA observed S2 is not associated to the facility nor finger print cleared. · At 10:39am, LPA observed kitchen and dining room floor buckling. · At 10:51am, LPA observed fabreeze in an unlocked cabinet located in the hallway. · At 11:08am, LPA observed knives, scissors and lighter in a unlocked drawer located in the kitchen. · At 11:10am, LPA observed medication in an unlocked drawer located in the kitchen. · At 11:13am, LPA observed hot water temperature at 142.2 degrees F. · At 11:22am, LPA observed screen door large box, bed frames and rails, washing machine, mattress pads located in the back and side yard. · At 11:23am, LPA observed the fence located in the back yard has planks missing and on both sides fence is leaning. · At 11:31am, LPA observed facility using residents closets for storage, mattresses and boxes behind the sectional in the common area, the hallway and resident bathroom. Continue on LIC 809C Continue from LIC 809C LPA requested the following documents to be submitted to CCLD by 5/10/2024. · 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 Copy of Current Administrator Certificate 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 $100.00 civil penalty will be assessed on today's date for associations.* Exit interview conducted. A copy of the LIC421BG, this report and appeal rights provided