Routine inspection·November 4, 2022

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit to the facility for the purpose of conducting a required annual inspection using the Infection Control Evaluation Tool. LPA Maldonado met with the licensee Jasaiel De Leon and explained the purpose for the visit. LPA conducted a tour of he physical plant with the licensee, observed COVID-19 procedures, food supply, reviewed residents' medications, and resident and staff files. Facility has submitted a mitigation plan and the plan has been approved. The facility is a one-story home, located in a residential area and is licensed to serve (6) residents, ages 60 and over. The license is approved for (6) non-ambulatory residents, approved hospice waiver for (1), and approved dementia care plan. The home consists of (4) resident bedrooms, (2) bathrooms, kitchen, dining room, living room, laundry room, a shaded patio in the backyard, and a detached garage. (1) resident bedroom is shared and (3) are private. LPA observed all resident bedrooms to have the required furniture, linens, and closets with additional storage space. Additional clean linens were observed in a hallway closet and were observed to be in good condition. All entrances/exits were observed to have operating auditory devices during the visit. All walkways and pathways were observed to be free of obstructions and hazards. The food supplies in the facility was observed to be a variety of nutritious foods. The required 2-day of perishables and 7-day non-perishables foods were observed in the kitchen and outside refrigerators, as well as in the pantry. All cleaning supplies/toxins were observed inaccessible in a cabinet in the locked laundry room and all sharps were locked and inaccessible in a kitchen drawer, across from the refrigerator. A fire extinguisher was observed in the kitchen to have a recent inspection and be fully charged. LPA observed the bathrooms in the home to have a toilet, shower, and wash basin- all in good repair and operational. The water temperature was tested and measured at 116.8*F in bathroom#1 and 115.3*F in bathroom#2. (Report Continued on LIC809-C...) Smoke/carbon monoxide detectors were observed throughout the facility and were operational upon testing. The First Aid Kit was observed to have the required items and First Aid Manual. LPA did not observe COVID-19 signange posted throughout the facility to promote mask wearing, cough/sneeze etiquette, and social distancing. A sufficient 30-day supply of Personal Protective Equipment (PPE) was observed in the garage and throughout the facility, accessible to residents, staff, and visitors. There is a central entry point designated for temperature/symptom screening. All hand washing stations were observed to have sufficient soap and paper towels. LPA reviewed 5 resident files. Files were complete with health screenings and updated emergency contact information. During the resident file review, it was discovered that 2 residents with dementia did not have updated Physician's Reports, as required. LPA also reviewed 3 staff files to confirm health screenings, fingerprint clearances and required training certification. LPA reviewed 5 residents' medications. Medications are documented properly and given as prescribed. During the medication review, it was discovered that 2 of 5 resident medications did not have proper labels on the bottles, although they are prescribed. Per California Code of Regulations and Health and Safety Codes, deficiencies were observed and will be cited on the LIC809-D report. An exit interview was conducted with licensee Jasaiel De Leon and a copy of the report and appeal rights were provided.