Routine inspection·March 7, 2024

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility background was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by Facility Manager Angelica Quintero. LPA discussed the purpose of the visit with Facility Manager Quintero. According to the facility’s license, there may be a maximum of 12 residents all of whom may be non-ambulatory; 4 of which may be bedridden with rooms 5 and 6 to be used for bedridden residents; and hospice is approved for 4 residents, in at any given time at the facility site. During today’s inspection, the facility’s current census is 8 residents living at the facility. There were 8 residents present at the facility site during the inspection. LPA, accompanied by House Manager Quintero, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, between 73-degrees and 76-degrees Fahrenheit (F). Hot water temperature at taps accessible to clients were not all compliant: kitchen sink delivered hot water at 145 degrees F but according to staff is only used by staff; sink in restroom #1 delivered hot water at 138.6 degrees F; sink in restroom #2 delivered hot water at 137 degrees F; hot water in restroom #3 delivered hot water at 116.4 degrees F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present, and all safely stored. There were no toxic chemicals/poisons accessible to residents. Medications were properly labeled, as required, and stored in a locked cabinet. LPA inspected the medication and found that medications were properly labeled. The facility-maintained medication logs which LPA reviewed. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] No pools or bodies of water on the premises. Per Facility Manager Quintero, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present (03) and serviced within the last 12 months. First aid kit was complete and readily accessible. LPA interviewed residents and staff. LPA reviewed staff and resident records. During today’s visit there were 8 residents on the facility premise but one left during the visit. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility. There were deficiencies observed and cited during today's annual inspection and may be reviewed on the LIC809-D page of this report. An exit interview was conducted with House Manager Angelica Quintero to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received. LPA requested House Manager Quintero to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, Emergency Disaster Plan LIC 610-E, and Residential Infection Control Plan LIC 9282 (6/23), to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov .