Routine inspection·August 29, 2022

On 8/29/22 at 9:00 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry. House Manager Elizabeth Ramos arrived a short time later and Licensee/Administrator Jason Johnson arrived towards the end of the inspection. Two residents and one staff was present during the inspection. LPA conducted tour with staff and did not observe any obstructions. No fire issues observed. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Hand washing posters were observed by the bathroom sinks. Bedrooms were checked and residents do not share bedrooms. LPA checked residents’ medications. Food supply was observed in adequate supply. Cleaning and PPE supplies were checked. Resident files have updated emergency contact information. Administrator certificate is valid. The following deficiencies were observed: 1. S1 does not have fingerprint transfer clearance and has been working in the facility since 6/7/22. 2. One bottle of cleaner observed accessible in cabinet under hall bathroom sink, and storage cabinet in garage where all cleaners and chemicals are stored was observed unlocked and accessible. 3. S1 did not have a health assessment completed and has been working since 6/7/22. 4. LPA observed master bathroom shower did not have a non-skid mat or strips available. 5. Upon LPA entry, S1 was only staff on duty and stepped out of the front door to guide LPA to office next door, leaving two residents unsupervised. Continue on LIC809-C. Continued from LIC809. Deficiencies are being cited based on LPA observation, interview, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A civil penalty is being assessed in the amount of $100 per day, for a maximum of 5 days, for a total of $500. See LIC421BG for more details. The following updated forms to be sent to CCL within 2 weeks: LIC500, LIC308, LIC610E, Proof of Liability insurance Exit interview conducted. A copy of this report and a Plan of Correction was reviewed and developed with Licensee Jason Johnson, whose signature confirms receipt of this report. Appeal rights were provided to Licensee as well.