Routine inspection·April 5, 2024

Licensing Program Analysts (LPAs) Erik Zaragoza conducted an unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Michelle Laude, caregiver for the facility, and was granted entrance. Administrator Wilma Carstenson arrived shortly thereafter. There are four (4) residents currently living in the facility. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control practices and Personal Protective Equipment (PPEs) were observed. Infection Control Plan will be submitted to LPA within seven (7) days. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) residents, all of which may be non-ambulatory, four (4) may be receiving hospice. It has four (4) resident bedrooms, a dining room, a living room, a kitchen which contains the washer and dryer machines for the facility, two (2) residents bathrooms of which Restroom #1 had a hot water temperature reading at 109.7 Degrees F and Restroom #2 had a hot water temperature reading of 107.2 Degrees F, a backyard patio which contained a shaded area for residents, and also a detached garage that functions as the facility’s storage and holds additional food and incontinence supplies. Cleaning supplies and chemicals are kept locked in the kitchen of the facility. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. The facility has two (2) fully charged fire extinguisher located on both floors of the facility, including the basement. There were no sharp objects that were left accessible to residents. · Water temperature readings measured between the required 105 - 120 degrees Fahrenheit. Operational Requirements: · Fire clearance was approved by LA County Fire Department for a capacity of six (6) residents, all of which may be non-ambulatory, four (4) may be receiving hospice. · Care and supervision to meet the clients’ needs was observed. Resident Rights/Information: · Physician orders were reviewed for four (4) resident files. · Medications were also reviewed for four (4) residents. Resident Records/Incident Reports: · Four (4) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. 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. Due to time constraints, LPA was not able to complete the annual inspection at this time. LPA will return at a later date to complete the inspection. Exit interview held and a copy of the report was provided.