Routine inspection·November 13, 2023

On 11/13/2023 at around 9:20 AM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with the Administrator Minnie Joy Membrebe. LPA explained the purpose of the visit and was accompanied by the Administrator inside and outside the facility during this inspection. This facility is licensed to serve 6 non-ambulatory adults ages 60 and above. A total of 3 non-ambulatory residents are currently residing in this facility. The facility has a past due balance of $2,226 due on the 9/04/2023. The home consists of 4 resident bedrooms, a total of 2 staff bedrooms, 3 resident bathrooms, 1 living room, 1 family/tv room, 1 kitchen, 1 backyard patio area with shaded seating, and 1 garage – converted to 1 office, 1 staff bedroom, and 1 staff bathroom. Outside grounds were toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to residents. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPA toured the kitchen area and observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept in a locked storage cabinet. LPA observed that medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. Last Disaster drill was conducted on September, 2023. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors were in compliance and operational. A new fire extinguisher was observed in the kitchen. Facility does not have an internet access device dedicated for resident use. LPA did not observe Liability Insurance. 4 out of 4 resident bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit. This facility provides residents with hygiene products such as feminine napkins, nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb. 3 resident records were reviewed and, 3 out of 3 resident records had Admission Agreements, Consent Forms, Weight Record, Emergency Information, Appraisal & Needs Service Plan, Tuberculosis Test, Centrally Stored Medication Destruction Record, and Personal Rights. 2 out of 3 residents did not have an updated medical assessment. 3 staff records were reviewed, 3 out of 3 staff records had current First Aid Certificates, Criminal Record Clearances, Job Application, Tuberculosis Test, and signed Employee Rights. Deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A violation regarding, internet access device, liability insurance, and medical assessments. An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Administrator.