Routine inspection·December 29, 2023

On 12/29/2023 at 10:35AM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Debbie Rubillos and explained the purpose of the visit. Debbie phoned the Licensee, Josefina "Penny" Gardner to inform. Penny arrived at the facility approximately 11:40AM. The Administrator, Andrew Gardener, was not available. The facility’s fire clearance was approved for a resident capacity of 6 Non-Ambulatory. Hospice waiver approved for 6 residents. Administrator's Certificate #6054460740 Expires 01/05/2024. Penny gave Debbie Rubillos authorization to sign report. LPA toured facility with Penny 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 small room offside the dining room 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 72 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 bathroom was measured at 108.8 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. LIC809-C Continued... LIC809-C Continued... Smoke and carbon monoxide detectors were in operating condition during visit. New fire extinguisher were purchased 06/13/2023. Emergency Disaster Plan was last posted on 10/02/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 10/02/2023. At 10:50AM, LPA reviewed 5 residents records. At 12:00PM, LPA reviewed 7 staff records and 5 of 7 have current first aid training and associated to the facility. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 1:16PM LPA observed prescription insulin located in refrigerator unlocked 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 CCLD by 01/05/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report Liability Insurance Exit interview conducted. Appeal Rights and a copy of this report provided.