Routine inspection·April 6, 2023

On 4/6/2023 at 9:40 AM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct 1 Year Annual Required inspection. LPA was greeted by Caregiver Elmer Ferrer. Administrator, Shahid Siddiqui, arrived at 10:12 AM. LPA explained the purpose of the visit. Administrator left the facility around 12:30 PM and allowed Elmer to sign the documents. The facility’s fire clearance was approved for 7 Non-Ambulatory and 1 Bedridden. LPA toured facility with Shahid including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 9 total bedrooms which 8 bedrooms are occupied by the residents and 1 bedroom 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 77 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. T he hot water temperature in the residents’ shared bathroom was measured at 120 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. LPA observed carbon monoxide and smoke detectors were in operating condition during visit, smoke detectors are connected to the sprinkler system. Fire extinguisher was last serviced on 10/20/2022. Emergency disaster drill was last conducted on 11/2023. Report continues on 809 C. At 10:55 AM, LPA reviewed 6 residents records. At 11:55 AM LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. At 12:25 PM LPA reviewed a sample of 3 resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 4/28/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: -At approximately 12:40 PM LPA observed that the first aid kit was incomplete. The following deficiency was 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. Exit interview conducted. Appeal Rights and a copy of this report provided.