Routine inspection·June 20, 2023

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 12:00 p.m., the LPA met with staff and explained the reason for it visit. At 12:27 p.m., the Licensee arrived at the facility. At 12:45 p.m., the LPA, along with the Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 1:17 p.m., hot water measured at 106.3-degree Fahrenheit. Medications are located in a locked kitchen cabinet. However, at 12:48 p.m., the LPA observed medication accessible in the refrigerator. The Licensee explained that she will ensure that the medications will be locked and inaccessible. BEDROOMS: The facility is a single-story residential home with three (3) bedrooms and one (1) bathroom for resident's use. There is an additional bedroom for staff use, which remains locked. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. At 12:52 p.m., the LPA observed Resident #1 (R1) residing in room three (3), which is not the identified bedridden room. Per R1’s physician’s report, R1 is identified as bedridden. Per the fire clearance, a bedridden resident can only reside in Bedroom #1. An immediate civil penalty of $500 is assessed, due to a violation of the fire clearance. Continued on LIC 809-C. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 1:15 p.m., hot water 105.6-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. There is a washer and dryer located in the staff restroom. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the staff restroom. The first aid kit observed in the staff restroom. OUTDOOR SPACE: At 1:20 p.m., the LPA observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. Passageways were free and clear from obstruction. There are no bodies of water on the premises. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and purchased on 05/21/2023. At 1:18 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Night lights were present in the hallways and passages. All exits have functioning auditory devices and were operational at the time of the visit. RECORD REVIEWS: Between 1:27 p.m. and 2:50 p.m., the LPA conducted a file review for all residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All files were in order. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8 and California Health and Safety Code the following deficiencies were cited (refer to LIC 809-D). Civil Penalties assessed in the amount of $500. Failure to correct the deficiencies may result in additional civil penalties Due to time constraints the LPA will return to complete the annual at a later date. Exit interview conducted. A copy of the report and and appeal rights were issued.