Routine inspection·December 8, 2022

On 12/08/2022 at 10:35 AM, Licensing Program Analysts (LPAs) L. Alexander and C. Fowler arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Epifania "Nanette" Angcla and explained the purpose of the visit. Nanette called the Administrator, Josefina "Penny" Gardner. Penny arrived approximately at 11:25 AM. LPAs toured facility with including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 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 77 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 non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. During record review, LPAs observed facility has a copy of the infection control plan on file. LPAs observed food and paper supplies are sufficient. The following deficiencies were observed: At 11:04 AM LPAs observed bleach, Pine-Sol, ammonia, window cleaner, Lysol spray, Pledge cleaner. At 11:05 AM LPAs observed hammer, scissors, screw driver. At 11:06 AM LPAs Tide Laundry Detergent PODS. At 11:08 AM LPAs observed incense, sage, strawberry margarita mix in the garage. At 11:21 AM LPAs observed planks of wood, tools, puddy, paint can, caulking . Continued on LIC809C Continued from LIC809 At 11:23 AM LPAs observed locked gate (Easement exit per Penny). At 11:24 AM LPAs observed planks of wood, table, blinds, plant soil. At 11:25 AM LPAs observed concrete, door screens, wood behind shed. At 11:25 AM LPAs observed locked gate (front). At 11:26 AM LPAs observed WD-40, saw, hammer, monkey wrench, moving dolly. At 11:28 AM LPAs observed plant soil by outdoor patio furniture. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 12/15/2022: 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 Monkey Pox Mitigation Plan Exit interview conducted. Appeal Rights and a copy of this report provided.