Routine inspection·February 9, 2024

At 11:10 AM Licensing Program Analysts (LPAs), Huma Rahimi, and Perchui Milena Khurshudyan conducted an unannounced annual inspection at the facility mentioned above. LPAs met with Staff Lucena Dagoy, and at 11:45 AM the Administrator Elizabeth A Dagoy arrived at the facility and LPAs explained the reason for the visit. At 12:10 PM, Physical tour was conducted with the Administrator and LPAs observed the following: Censes: The current censes is 0. Kitchen: At approximately, 12:13 PM LPAs toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. LPAs observed sharps to be locked and stored in a cabinet near the exit door to the back of the kitchen. LPAs observed toxins, cleaning solutions, and soap stored and locked underneath the kitchen cabinet sink. Medications: The facility do not have any residents; therefore, no medications were observed. In the living room, the facility is having a chest drawer in which they keep the medications locked. Bedrooms: The facility has four (4) bedrooms. One of the bedrooms is designated for live-in staff. LPAs observed the staff room to be free of hazard and locked. LPAs observed all bedrooms to be clean and clear from obstruction, properly furnished, sufficient lighting, appropriate bedding and linens. Trash cans observed to have attached lid. Bathrooms: At 12:20 PM, LPAs observed the bathrooms to be clean and in good repair. LPAs observed the appropriate grab bars in and around the toilet and shower also non-skid mats are located in the shower area. The water temperature measured 119.2 degrees Fahrenheit. Hand towels and wash clothes are not shared Continue on LIC809-C Common Areas : The facility maintains a comfortable temperature at 68°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. The garage is currently being used for storage and laundry. Laundry detergents, cleaning agents and other toxins are locked away. Smoke detectors/carbon monoxide . At 12:28 PM, the fire alarm system was tested and observed to be working, it is hard wired and interconnected. The carbon monoxide detector is located on the wall in the kitchen. Outside areas: At 12:35 PM, LPAs observed the backyard and surrounding area of the facility to be clean and clear from debris. A covered canopy area with tables and chairs for lounging, the front porch area is shaded with chairs for lounging. A detached garage observed to be locked and currently used as storage. No bodies of water observed on the premises. Laundry Room: LPAs observed the washing machines located outside in the back of the facility. LPAs observed to be clean and clear from obstruction. Laundry soap, toxins and cleaning supplies are stored outside on a shelf near the laundry machines, inaccessible to residents. Between 1:00 PM to 1:30 PM, LPAs reviewed records of one (1) resident (R1) and two (2) staff. LPAs reviewed all incident reports on a system and did not observe an Incident Report regarding R1. In addition, the Administrator admitted that no incident was submitted to the Community Care Licensing Department (CCLD) in a timely manner. Based on Title 22 Regulation: a written Unusual Incident / Injury Report / Death shall be submitted to CCLD within seven (7) days of occurrence. LPA informed the Administrator that all staff members are mandated reporters, and they are all responsible for reporting. Additionally, upon request of the Certificate of Liability Insurance, the Administrator stated that they cancelled the insurance due to the financial hardship on or about July, 2023. Continue on LIC 809C LPA informed the Administrator to submit the following one (1) Death Report that occurred on: · 01/14/24 · Certificate of Liability Insurance Per the California Code of Regulations, Title 22, deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.