Routine inspection·April 24, 2024

On 04/24/2024 at 12:40PM, Licensing Program Analysts (LPAs) T. Syess-Gibson and C. Fowler conducted an unannounced 1-Year Required inspection. LPAs met with House manager Marilou Intog, and explained the purpose of the visit. Marilou called the Administrator who arrived to the facility at 3:04PM. Administrator currently holds a certificate (#7035384740) that expires on 10/04/2025. Facility has census of 6. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPAs toured the facility with House Manger including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) bathrooms. LPAs did not observe any bodies of water. A comfortable temperature is maintained at 74 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 113.7 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 007/19/2023. Emergency Disaster Plan was last posted on 11/03/2023. First aid kit was observed to be complete. Fire drill was last conducted on 03/16/2022. Four (4) staff records were reviewed. During record review . LPA reviewed three (3) resident records, and they were current and complete. Continued on LIC809C. Continued from LIC809. LPAs requested the following documents to be submitted to CCLD by 05/01/2024. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance LPAs observed the following deficiencies: At 12:55pm LPAs observed medications in an unlocked cabinet in kitchen At 1:00pm LPAs observed disinfectants in unlocked cabinet under kitchen sink At 1:15pm LPAs observed bleach, fabuloso, comet and Lysol spray under the unlocked sink cabinet in the common bathroom At 1:18pm LPAs observed a room with a bed and clothing in closet in common bathroom At 1:25pm LPAs observed a lawn mower, area rug, and exercise equipment near emergency exit gate Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. 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. Exit interview conducted. A copy of this report and appeal rights provided.