Routine inspection·November 15, 2024

On 11/15/2024 at approximately 11:00am an unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan. Upon arrival, LPA met with the caregiver Rose Hugal, who granted access to the facility. LPA explained the reason for the visit. Shortly after the Administrator, Mary Jane Garner arrived and helped with physical plant tour and staff/residents files. During today's visit, LPA conducted a physical plant walk through, at approximately 11:30am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22. The following was observed: The facility is a single-story home and is licensed for capacity of six (6) residents, of which five (5) may be Non-Ambulatory and one (1) bedridden for bedroom #2. Facility also has a hospice waiver for one (1) resident. There are five (5) bedrooms in the facility of which four (4) are designated for residents’ use. All bedrooms observed to be appropriately furnished except bedroom #4 had broken furniture/chest. All bedrooms have appropriate lighting. There are three (3) bathrooms in the facility of which two (2) are designated for residents’ use. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 11:45 to be 107°F. Extra towels and linens were readily available. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination. LPA observed facility alarms were off on all exit doors. SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 1:00pm they were tested and observed to be operational. The facility has two (2) fire extinguishers that were last purchased on May 3rd, 2024. Continue on LIC809-C KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven, dish washer and sink. The kitchen appliances and fixtures were functional. LPA observed the kitchen area, there was sufficient stock of one week non-perishable foods and two days of perishable foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. LPA observed that sharp objects were stored in a locked drawer inaccessible to residents in care. Extra emergency food was properly stored inside the storage cabinet. The common areas which include dining and living room appeared clean and were properly furnished. Temperature was comfortable it was measured at 12:00pm to be 70°F. No obstructions and or tripping hazards throughout the facility found. MEDICATION: LPA observed centrally stored medication, facility staff/resident files, and First Aid kit locked in the kitchen cabinet and inaccessible to residents in care. LPA observed First-aid kit is complete and has new manual. Facility has Dementia Care Program. PRN medications have written orders from a physician. The facility serves residents with dementia and facility has trained staff to meet the needs of residents who are diagnosed with dementia. Potentially dangerous items are kept inaccessible to residents in care. Facility has 2 staff for AM shift and 1 awake caregiver for PM shift. COMMON AREAS: LPA observed two (2) living rooms and a dining room that appeared generally clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Facility has land line, LPA checked its operational. LAUNDRY ROOM: Laundry machines are located in the separate closed door area next to the kitchen. LPA observed all chemicals and detergents are kept locked and inaccessible to residents in care. SURROUNDING GROUNDS: LPA observed sufficient yard space with fenced backyard. Appropriate outdoor furniture, with covered shaded area was available for residents at the front area of the house. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. Exit doors were unlocked and free of obstructions. The facility does not have a swimming pool or body of water. There is no garage in the property. FILE REVIEW : Between 12:00pm to 2:30pm, LPA reviewed records and files of three (3) residents and three (3)staff/caregivers. A review of staff and resident records appeared to be complete. Resident’s files contain assigned admission agreements and a medical assessment, and all other required documentarians. Continue on LIC809-C A review of staff records indicates that all facility staff and who required caregiver background checks have received criminal record clearances. There are no residents with prohibited conditions residing at the facility. Facility also provides activities to the residents. An emergency exit plan/sketch along with other posting requirements are posted on the wall in the living room. The following deficiencies were observed (see LIC809D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. LPA collected LIC500, LIC9020, copy of Administrator's certificate and Infection Control / Mitigation Plan. The Administrator stated that the facility currently does not have a Liability Insurance. Exit interview conducted and copy of this report signed and delivered.