Routine inspection·June 20, 2024

On 6/20/2024 at 11:45 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Emilia Estonilo and explained the purpose of the visit. Backup Administrator, Aljolyn Martinez arrived at 1:03pm. The facility’s fire clearance was approved for 6 non-ambulatory. LPA toured facility with Backup Administrator, Aljolyn Martinez including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 bedrooms are occupied by the residents and 1 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 72 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 bathrooms was measured between 105-120 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. LPA observed centrally stored medication and sharps secured using a baby proof strap lock. LPA advised administrator it needs to be switched to a secured lock that requires a device, code, or key to open it. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 4/18/2024. Emergency Disaster Plan was last posted on 6/20/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 3/10/2024. At 11:50am, LPA reviewed 6 residents records. At 12:20pm, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. Report continues on LIC809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: While in the first bathroom LPA observed that no paper towels were available to dry hands and the only available item was a shared hand towel. LPA observed medications in cup unlocked in R3's room in the bedside drawer. R3 has dementia. LPA observed rooms built in the garage for caregivers that are not cleared on the facility sketch and no permit was obtained prior. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 7/01/2024: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report Updated facility sketch 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.