Routine inspection·July 25, 2024

On 07/25/2024, Licensing Program Analysts (LPAs) K.Kaur and M. Vega arrived at the facility unannounced to conduct an Annual Required Inspection. LPAs introduced selves, stated the purpose of the visit and was allowed entry into the facility by staff Lilia Yumol. Facility Staff contacted Administrator, Joycelyn Hopper via telephone. Administrator arrived a short time later. LPAs toured the facility inside and out. Facility observed to be clean, odor free and at a comfortable temperature. Pathways and doors were clear and free from obstruction. Common areas were clean, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced 1/14/2024. Resident rooms observed to have the required furnishings. LPA observed sufficient seating in living room. At 12:43 PM LPAs observed the centrally stored medication cabinet was unlocked. Tour continued to Kitchen and dining area which were clean and had sufficient seating. At 12:48 PM LPAs did not observe a 7-day supply of non-perishable foods. At 12:50 PM LPAs observed cleaning supplies and chemicals unlocked in a cabinet under the kitchen sink. Laundry area and office toured. Office has locked chemicals and sharps. LPA observed freezer in the garage. The exterior tour was conducted. The backyard was observed to have sufficient seating. At 12:53 PM LPAs observed a patio that was under construction. LPAs interviewed Licensee and were informed CCLD was not informed, and a permit has not been obtained. At 12:56 PM LPAs observed paint cans in the open garage. Backyard gate is self-closing and self-latching. Resident's records contained signed Admission Agreement, Personal Rights, and current Physician's Report and ID Documentation. Staff files were reviewed for good health. At 3:38 PM LPAs observed PRN medication was not logged with the required information. At 3:42 PM LPAs observed live in staff had an expired CPR certificate. At 4:14 PM LPAs reviewed residents P & I records and observed resident’s monies were deposited into a bank account that also holds facility funds. Continued to Next Page Deficiencies are being cited in accordance with California Code of Regulations, Title 22, Division 6 on the attached 809D. LPA requested the following documents to be submitted to CCL by 8/1/2024: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file. Exit interview conducted and a plan of correction was reviewed and developed with Administrator. A copy of this report and appeal rights was discussed and provided to Administrator, whose signature on this form confirms receipt of this document.