Routine inspection·December 20, 2023

On 12/20/2023 at 4:00pm, Licensing Program Analysts (LPAs) L. Hall and T. Syess-Gibson, conducted an unannounced 1-Year Required inspection. LPAs met with Joevy Madamba, Caregiver and explained the purpose of the visit. Administrator, Helen Herbert, arrived at 4:19pm. The facility’s fire clearance was approved for four (4) non-ambulatory and 2 bedridden residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of five (5) total bedrooms one (1) is occupied by staff, and one (1) bathroom. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 70 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 115.3 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/ carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 4/27/2023. Emergency Disaster Plan was last posted on 2/10/2023. First aid kit was observed to be complete. Continued on LIC809. Continued from LIC809. Four (5) staff records were reviewed, and all staff have criminal record clearance. All six (6) resident records were reviewed and one (1) did not have current physician's reports. LPA requested the following documents to be submitted to CCLD by 12/29/2023 . LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization Resident roster Liability Insurance LPA observed the following deficiencies: At 4;35pm, LPAs observed during record review R1 did not have a current physican's report. At 5:25pm, LPA observed portable heaters in three (3) residents bedrooms. 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 the appeal rights and this report provided.