Routine inspection·November 19, 2024

Licensing Program Analysts (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Licensee Percy Olidan. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. An Infection Control Plan was observed Physical Plant/Environment Safety: (2) Living rooms, kitchen, dining area, (6) bedrooms of which (3) are for resident use, (4) bathrooms, (1) office, outdoor kitchen/laundry area and a detached storage room. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are enclosed ponds in the backyard. Cleaning supplies and toxic substances are inaccessible. Water temperature readings measured within title 22 regulations. Operational Requirements: A current Plan of Operation observed. Dementia Care Plan Observed A fire clearance for 6 residents of which (6) may be non ambulatory Hospice care waiver approved for up to one (1) resident. Facility does not have an active liability insurance. Personnel Records - Staff Training: Administrator on file is not current and administrator certificate for licensee and current administrator is currently expired. Two (2) staff files were reviewed. Required documents observed for files reviewed. Continued on LIC 809-C Staffing: Sufficient staff observed during visit Resident Records - Incident Reports: A total of two (2) resident files were reviewed. (1) resident is missing a medical assessment. Resident Rights - Information Required postings observed Food Service: Sanitation practices and kitchen cleanliness was observed. Kitchen has utensils for clients to use and to store their meals Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Activities supply observed Incident Medical and Dental: Emergency transportation available First Aid Kid observed (2) of (2) Resident medications reviewed Disaster Preparedness: Emergency and Disaster Plan observed but is outdated. Last Emergency Drill observed Residents with Special Health Needs: Needs and Services Plans are on file. Currently (0) residents receiving hospice services. Inspection Tool was completed and per Title 22 deficiencies are being cited on todays visit. See 809-D pages attached Exit interview conducted. Copy of this report and appeal rights were discussed and provided.