Routine inspection·February 21, 2024

At approximately 4:15PM, Licensing Program Analysts (LPAs) Carol Fowler and Tonica Syess-Gibson arrived unannounced to conduct a Required 1 Year annual inspection and met with Caregivers, Thelma Hababag and Renato Hababag. Ronan Rances, Administrator arrived at 4:59PM. Facility has an approved fire clearance for 2 ambulatory and 4 non-ambulatory residents for a total capacity of 6 residents. LPAs conducted a tour of the facility and observed the following: the facility was clean and at a comfortable temperature 73 degrees with all exits free from obstruction. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Toxins were secure and not accessible to residents. There is a sufficient supply of hygiene products, paper products, and linens available for resident use. LPAs reviewed 5 resident records which were incomplete. LPAs reviewed three (3) staff records which S2 and S3 were incomplete . LPAs reviewed three staff files. Administrator's Certificate #6025731740 was current with an expiration date of 03/06/2024. The facility last fire and evacuation drill was conducted on 01/05/2024. Facility's fire extinguishers were last inspected 01/09/2024. Emergency Disaster Plan updated on 01/08/2024 Smoke detectors and carbon monoxide detectors were tested and operational. The amount of fresh and non-perishable foods are within regulation. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Continued on LIC809C. Continued from LIC809. LPA requested the following documents to be submitted to CCLD by 2/28/2024. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance LPAs interviewed one (1) resident. LPAs observed the following deficiencies: At 4:47pm, LPAs observed screen in shared bathroom was ripped. At 4:59pm, LPAs observed unlocked medication in kitchen cabinet. 5:24pm, LPAs observed record review two (2) out of three (3) files reviewed were incomplete. 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 and a copy of this report and appeal rights provided.