Routine inspection·July 22, 2023

Licensing Program Analyst (LPA) Bennette Pena conducted the required annual inspection. LPA was allowed entry by Teresita Pugado, Caregiver and explained the purpose of today's visit. At 4:10pm, Administrator Ronald Barit arrived and assisted LPA with the inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is no visitor sign-in station. The facility has submitted an Infection Control Plan on 6/20/2022. The facility has also submitted a COVID-19 Mitigation Plan. Facility does not have COVID-19 signage posted in the facility. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements. Operational Requirements: A Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. Administrator will submit an updated Infection Control Plan to Licensing as required. L iability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 4/19/2024. Surety bond of $4,000.00 is current and will expire on 5/02/2026. Care and supervision to meet the residents needs was observed. Physical Plant/Environment Safety: The interior and exterior physical plant was inspecte d. The facility is a single storey home located in a residential neighborhood. It is licensed for 6 non ambulatory residents age 60 and above. Rooms #1, 2, 3 & 4 are cleared for 1 non ambulatory each. Room #5 is cleared for 2 non ambulatory and bedridden fire clearance. It consists of five (5) resident rooms, (2) of the rooms are divide d by curtains, one (1) staff bedroom, three (3) full bathrooms, living room, kitchen, dining room, carport and backyard with covered patio. At 4:02pm, water temperature readings measured above the required 105 - 120 degrees Fahrenheit. Water temperature read at 122.5 degrees F bathroom #1, 125.9 degrees F bathroom #2 and 126.8 degrees F in bathroom #3. At 5pm, LPA re-measured the water temperature readings and measured between 109.1-115.1 degrees F which is within Title 22 Regulations requirement. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors are operational. Cameras are operational and located in the front and side of the house. The facility has (1) fire extinguisher located between the kitchen and dining room and was last serviced on 01/15/2023. Cleaning supplies and toxic substances are inaccessible to clients. *****CONTINUED ON LIC809-C***** Staffing: A total of three (3) staff members including the Administrator provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance and have the required training and associated to the facility. One (1) of the staff members did not have valid First Aid training certificate and last training expired on 4/20/2023. Personnel Records-Training: Administrator certificate expires 2/19/2024. Administrator stated that the change of Administrator request will be sent to the Woodland Hills Office. Staff have criminal background clearance and training. Two (2) staff files were reviewed. Personnel records have health/TB screenings and First Aid/CPR training. Resident Records-Incident Reports: A total of three (3) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisal, Individual Service Plans, TB clearance, Functional Capability Assessment, Physician's Orders, medical consent, and medication records. Resident Rights-Information: Resident personal rights are posted. Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. Facility has an activity calendar provided to the residents. Food Service: The kitchen was inspected and has sufficient supply of 2-day perishable & 7 day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. The food is properly stored in the refrigerator (clean, labeled and well maintained). Pesticides and cleaning supplies are kept away from the food preparation areas. Plates, cups and utensils are kept cleaned and stored properly. Incident Medical and Dental: Three (3) centrally stored resident medications were reviewed; containing 30-day supply of medications. Medical and dental transportation is provided. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. Records of resident Appraisal and Needs services plans are part of Emergency training. Fire Drill was last conducted on 11/19/2020. Pursuant to Title 22, deficiency was cited on the attached 809D and Technical Assistance were issued. An exit interview was conducted, and a copy of this report was provided to Ronald Barit, Administrator.