Routine inspection·April 9, 2024

On 04/09/2024 at 1:30PM, Licensing Program Analyst (LPA) T.Syess-Gibson conducted an unannounced 1-Year Required inspection. LPM Harpreet Humpal was also present.. LPA met with Caregiver Niesha, spoke with Administrator, Nicolette Lake via telephone, and explained the purpose of the visit. The Administrator arrived at 1:45PM and c) that expires on 08/07/2024. The facility’s fire clearance was approved for four (4) non-ambulatory and two (2) bedridden residents. LPA toured the facility 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 75 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 111.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and no skid mats .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 serviced on 09/06/2023. Emergency Disaster Plan was last posted on 02/07/2024. First aid kit was observed to be complete Fire drill was last conducted on 01/07/2024. Continued on LIC809C. Continued from LIC809. LPA reviewed three (3) residents files they were all complete. Three (3) staff records, one (1) staff was missing health screening, First Aid/CPR and training. LPA reviewed a sample of medications. LPA observed the following deficiencies: · At 2;15pm, LPAs observed R1 in room two(2) with hospital bed with rail. · At 2:34pm, LPA observed S3 missing CPR/First Aid and Training for dementia. Deficiencies were 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. LPA requested the following documents to be submitted to CCLD by 04/16/2024. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report (updated) LIC 610E Emergency Disaster Plan Liability Insurance Exit interview conducted. A copy of this report and appeal rights provided.