Routine inspection·September 7, 2023

On 09/07/2023 at 2:00 PM, Licensing Program Manager (LPM) Ulysses Coronel and Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – Annual Inspection and met with Antonia Dionisio , Administrator. Five (5) residents and two (2) staff were present during this inspection. Facility is licensed to serve five (5) non-ambulatory residents and one (1) bedridden resident. The facility also has an approved hospice waiver for one (1) resident. The facility currently has 4 non-ambulatory resident s and 1 resident receiving hospice services. The home consists of 1 floor level with: 4 resident rooms, 2 restrooms, kitchen, dining room, laundry room, garage, and outdoor area. During today's visit, LPM and LPA conducted a tour of the physical plant, reviewed food supply, medication, emergency disaster plan (LIC610D) and infection control plan, and conducted interviews with two staff members and three residents. Deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A violation regarding criminal record clearance warrants an immediate civil penalty of $100.00 and is hereby assessed, see LIC421IM An exit interview was conducted, Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left wit Administrator, Antonia Dionisio.