Routine inspection·January 5, 2024

On 1/05/2024 at 9:30am, Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced 1-Year Required inspection. LPA met with Princess Nido, Caregiver, and explained the purpose of the visit. Cecilia San Diego-Tomas, Administrator arrived at 10:45am. The Administrator currently holds a certificate (#6048434740) that expires on 06/28/2024. The facility’s fire clearance was approved for four (4) non-ambulatory and four (4) bedridden residents. LPA toured the facility with Caregiver Princess Nido including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of four (4) total bedrooms, and three (3) bathrooms. No bodies of water observed. A comfortable temperature is maintained at 74.8 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 105.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. Smoke detectors and carbon monoxide were in operating condition during visit. New Fire extinguisher will be purchased on 01/06/2024. Emergency Disaster Plan was last posted on 1/15/2023. First aid kit was observed to be complete. LPA reviewed five (5) resident files and three (3) staff files which were found to be incomplete. Administrator had electronic copies of documents and will update resident and staff files. Continued on LIC809C. Continued from LIC809. LPA observed the following deficiencies: · At 10:21am, LPA observed 2 ladders, buckets, bedframes, concrete mix, paint, shovels, wood pallets, wood boards with nails, hoyer lyft, large umbrella frame located in the backyard. LPA requested the following documents to be submitted to CCLD by 1/12/2024. · 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 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. Exit interview conducted. A copy of this report along with appeal rights provided