Routine inspection·January 22, 2025

On 01/22/205 at 11:15AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Care Staff, Jose Eden De la Cruz and explained the purpose of the visit. The facility’s fire clearance was approved for five (5) non ambulatory and one (1) ambulatory residents. LPA toured the facility with Jose De la Cruz, Care staff including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three and half (3 1/2) bathrooms. four (4 bedrooms for residents, two (2) staff bedroom. All outdoor and indoor passageways are kept free of obstruction. LPA did not observe any bodies of water. 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 bathroom was measured at 106.0 degrees Fahrenheit. Residents’ bathrooms are equipped nonskid mats. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last service on 11/11/2024. Emergency Disaster Plan was last posted on 01/22/2025. First aid kit was observed to be complete. Fire drill conducted on 12/12/2024. Continue LIC809C. Continued from LIC809. Three (3) staff records were reviewed S2 and S3 were missing health screenings and S3 was not fingerprint cleared and associated to facility. LPA reviewed all three (3) resident records which were complete . The following deficiencies observed during visit. At 11:32AM, LPA observed R1, R2 and R3 had half bed rails. At 11:37AM, LPA observed no grab bars installed in shower of residents’ shared bathroom. At 11:43AM, LPA observed pledge multi surface spray, gorilla spray adhesive heavy duty, BAR spray and foam hardwood floor cleaner, Lysol sanitizer spray, The pink stuff- miracle cleaning paste, and maintex all-in-one multi surface cleaner in an unlocked cabinet under the kitchen sink. At 11:47AM, LPA observed R2 is in an ambulatory room, R2 is non ambulatory. At 11:51AM, LPA observed five (5) one (1) gallon BAHR paint and primer buckets and DAP pre-mixed stucco repair in garage with a turn lock. At 1:45PM, LPA observed during record review S2 and S3 were missing Health Screenings and S3 wasn’t associated or fingerprint cleared. LPA asked S3 to leave facility. The following forms to be updated and submitted to CCLD by 01/29/2025: LIC 308 Designation of Administrative Responsibility LIC 500 (updated) LIC 610D Emergency Disaster Plan Updated facility sketch Continued from LIC809C . Continued from LIC809C. * The total amount of civil penalties assessed on today's date $500.00 for staff (S3) not being fingerprint cleared . The following deficiencies was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency by POC date may result in additional Civil Penalties. Exit interview conducted. A copy the appeal rights, LIC421FC and this report provided.