Routine inspection·April 25, 2024

On 4/25/2024 at 9:15am, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-Year Required inspection. LPA met with Caregiver, Rodelia Pauligue . LPA spoke with Administrator, Elvira Vahid, via telephone and LPA explained the purpose of the visit. The Administrator currently holds a certificate (#6042528740) that expires on 10/23/2024. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Caregiver including but not limited to bedrooms, bathrooms, kitchen, garage, common area, and back yard. The facility consists of four (4) total bedrooms and three (3) bathrooms. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 68 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 124.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors/ carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 1/3/2024. First aid kit was observed to be complete. Fire drill was last conducted on 11/8/2023. Continued on LIC809. Continued from LIC809. Four (4) staff records were reviewed. One (1) staff did not have first aid and health screening. All five (5) resident records were reviewed and complete. LPA reviewed a sample of residents medication. LPA requested the following documents to be submitted to CCLD by 5/2/2024. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report Resident roster LIC 610E Emergency Disaster Plan (last page) Liability Insurance LPA observed the following deficiencies: At 10:15am, LPA observed bedroom #1 remodeled. Partial wall and a closet added. At 10:30am, LPA observed staff sleeping in garage. Two folding cots, clothing, medication, shoes, bedding. At 10:35am, LPA observed exit gate on left side of house with padlock. At 10:35am, LPA observed new ADU used for office in backyard. At 11:45am, LPA observed during record review R4 had prescribed medication that haven't been given. *An total amount of $500.00 will be cited on today's date for locked gate* 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. Exit interview conducted. A copy the appeal rights and this report provided.