Routine inspection·September 22, 2023

On 9/22/2023 at 12:50pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-Year Required inspection. LPA met with Eva Bode, Caregiver, and explained the purpose of the visit. Arvin Franco, Caregiver arrived at 1:15pm. The Administrator currently holds a certificate (#6040075740) that expires on 05/25/2024. The facility’s fire clearance was approved for six (6) ambulatory residents. LPA toured the facility with Caregiver including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of five (5) total bedrooms which one (1) bedroom is occupied by staff, and two (2) bathrooms. No bodies of water observed. A comfortable temperature is maintained at 74 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 135.7 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 02/2/2022. Emergency Disaster Plan was last posted on 10/08/2022. First aid kit was observed to be complete. Facility did not have Administrator file available and two (2) of the (3) staff files reviewed were incomplete. Both resident files were incomplete. Continued on LIC809C. Continued from LIC809. LPA observed the following deficiencies: At 12:55pm, LPA observed S2 and S3 was not associated to the facility. At 1:05pm, LPA observed windex, Lysol toilet cleaner, and Clorox disinfectant in unlocked cabinet underneath kitchen sink. At 1:10pm, LPA observed facility did not have 7-day of non-perishable and 2-day of perishable foods available for residents. At 1:13pm, LPA observed Clorox disinfectant underneath unlocked cabinet underneath bathroom sink. At 1:15pm, LPA observed hot water temperature at 135.7 degrees F. At 1:20pm, LPA observed six (6) different bottles of vitamins and medication, one being fish oil sitting on the night stand of R2. At 1:40pm, LPA observed during record review that facility did not have the administrator file available for review, and two (2) of the staff files were incomplete. At 2:00pm, LPA observed both resident files were incomplete. LPA requested the following documents to be submitted to CCLD by 9/29/2023. 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 Continued on LIC809C. Continued from LIC809C. 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. *An immediate $1000.00 civil penalty will be assessed on today's date for associations.* Exit interview conducted. A copy of the LIC421BG, this report and appeal rights provided