Routine inspection·October 15, 2024

On 10/15/2024 at 9:45am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-Year required inspection. LPA met with Ma Sinelita Rivera, Caregiver , and explained the purpose of the visit. LPA spoke with Ding Wang, Administrator via telephone and received approval for caregiver to sign documents. The facility’s fire clearance was approved for five (5) non-ambulatory, and one (1) bedridden resident. Facility has a hospice waiver for two (2). LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of eight (8) bedrooms and two (2) bathrooms. One (1) bedroom in the house and one (1) in the garage is occupied by staff. LPA did not observe any bodies of water. 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 99.3 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 had beeping low battery sound. First aid kit was observed to be complete. Continued on LIC809. Continued from LIC809. LPA reviewed three (3) staff files and none had first aid or CPR. All six (6) residents' files were reviewed and missing documents. LPA observed the following deficiencies: At 10:15am, LPA observed during record review R1, R2, and R3 does not have an exception for prohibited health condition. At 10:30am, LPA observed during record review that none of the residents have an appraisal needs and services plan. At 10:30am, LPA observed during record review R4 and R5 did not have a hospice care plan. At 10:30am, R1, R2, and R3 does not have a doctor's order for hospital bed with full rails. At 10:45am, LPA observed during record review Administrator's file was not available for review. At 10:45am, LPA observed the three (3) staff files reviewed did not have first aid or CPR. At 11:00am, LPA observed unlocked kitchen cabinet over dishwasher containing knives. At 11:05am, LPA observed R5's bed blocking patio exit in room #3, but on facility sketch it shows (#4). At 11:15am, LPA observed alterations completed at facility. Garage has a bedroom, bedroom added on side of living room (1), small staff room added behind laundry room and room #1 on facility sketch. At 11:20am, LPA observed facility did not complete a fire drill. At 11:25am, LPA observed fire extinguisher has not be repurchased or serviced. Continued on LIC809C. Continued from LIC809C. At 11:30am, LPA observed 6 hoyer lifts, a rolling tray, a hospital bed, and a wheelchair in the back yard. At 11:30am, LPA observed shed located in the back yard unlocked. LPA requested the following documents to be submitted to CCLD by 10/22/2024. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (9 pages) Liability insurance Deficiencies are 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. *An immediate civil penalty of $250.00 for a repeat violation will be assessed on today's date* Exit interview conducted. A copy of appeal rights, LIC421FC, and this report provided.