Routine inspection·January 8, 2025

On 01/08/2025 at 10:18AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct a 1-Year Required inspection. LPA met with Caregiver, Frances Bacus and explained the purpose of the visit. Frances called the Administrator, Kavitha Pramod via telephone. At approximately 11:15AM Administrator, Kavitha Pramod arrived. Administrator, Kavitha Pramod had to leave and gave authorization for Caregiver, Estrella Bumanglag to sign the reports. The facility’s fire clearance was approved for four (4) non-ambulatory and two (2) bedridden residents. LPA toured the facility with Caregiver, Frances Bacus including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms. and three (3) bathrooms. All outdoor and indoor passageways are kept free of obstruction. LPA did not observe any bodies of water. A comfortable temperature is maintained at 73 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 146.0 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/03/2024. Emergency Disaster Plan was last posted on 01/02/2025. First aid kit was observed to be complete. Fire drill was last conducted on 08/26/2024. Continued on LIC809C. Continued from LIC809. Five (5) staff records were reviewed and five (5) out of five (5) were first aid certified, and one (1) staff was not fingerprint cleared and associated to facility. LPA reviewed all five (5) resident records which were complete. LPA requested the following documents to be submitted to CCLD by 01/15/2025 : · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan · Liability Insurance LPA observed the following deficiencies: · At 10:26AM LPA observed water temperature in the shared bathroom measured at 146.0 degree Fahrenheit. · At 10:33AM, LPA observed unlocked kitchen cabinet with medications. · At 10:35AM LPA observed unlocked kitchen cabinet knives and a lighter. · At 11:02AM LPA observed a broken window located in the living room area. · At 11:05AM LPA observed an exit gate in disrepair in the backyard. · At 12:37PM LPA observed during record review and interview S1 was not fingerprint cleared and associated to the facility Continue on LIC809C Continued from LIC809C. * The total amount of civil penalties assessed on today's date is $1000.00. $500.00 for staff not being fingerprint cleared, $250.00 for repeat violation of regulation 87705(f)(1 ) and $250.00 for a repeat violation of regulation 87303(2) . 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. A copy the appeal rights, LIC421IM, LIC421FC and this report provided to Estrella Bumanglag.