Routine inspection·July 12, 2024

On 7/12/2024 at 10:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver/ House Manager, Gretchen "Cheche" Recto and explained the purpose of the visit. Administrator, Liwayway Mendoza arrived at 11:45AM. The facility’s fire clearance was approved for 6 non-ambulatory. LPA toured facility with House Manager including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 5 bedrooms are occupied by the residents and 2 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 70 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 113.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 6/10/2024. Emergency Disaster Plan was not posted. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 6/3/2024. At 10:30 AM, LPA reviewed 5 residents records. At 11:00 AM, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. At 11:20 AM, LPA reviewed a sample of resident’s medications. Report continues on LIC809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:30am during resident file review LPA observed R2, R3, R4, and R5 to have incomplete files. Each file was missing a different required document. Documents missing were admissions agreement, emergency ID, personal rights, and emergency medical consent forms. At 11:15am during file review LPA observed that facility does not have an updated emergency disaster plan available. The following deficiencies were 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.