Routine inspection·April 19, 2023

On 4/19/2023 at around 9:35AM, Licensing Program Analyst (LPA) Leslie Ibo arrived unannounced to conduct annual required inspection and greeted by staff (S2), after couple of minutes Administrator Nicollete Lake, arrived at the facility. LPA explained the purpose visit to S2 and to Administrator. LPA toured the entire premises with Administrator Nicollete, including but not limited to indoors and outdoors. The facility has 6 bedrooms, 4 bathrooms including 1 staff bathroom, 3 residents’ bathrooms, single story house per facility sketch. Six (6) bedrooms are designated for residents. Smoke detectors and carbon monoxide detectors were observed operational. The facility received a fire clearance dated 03/02/2021 with an approval for a total capacity of 6 residents , approved for 4 non-ambulatory & 2 bedridden for room number 5 & 2 only. LPA inspected 6 rooms. The facility was observed to be clean and odor free. LPA observed fire extinguisher located at the kitchen area with service date of September 6, 2022. There was sufficient supply of perishable and non perishable foods observed. Freezer temperature was observed at zero (0) degrees Fahrenheit. Refrigerator temperature measured at 40 degrees Fahrenheit. First aid kit was complete. Vehicle insurance and registration were verified as current. LPA reviewed medication and Medication Administration Record (MAR) with facility Administrator. ...Continues to LIC809C... LPA interviewed 2 staff and 3 out of 5 residents. At around 11am, LPA reviewed 4 resident files and 3 staff files. The following deficiencies were observed: At around 9:46AM, LPA observed pair of scissors inside unlocked drawer. At around 10:15AM, LPA observed unopened cleaning products stores with some food supplies. Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Exit interview was conducted with Administrator and Appeal Rights was provided.