Routine inspection·April 12, 2023

On 04/12/2023 at 9:49 a.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility listed above to conduct an unannounced annual inspection. LPA observed appropriate Covid-19 postings on the outside of front door. LPA was greeted by Maria Ana Rodriguez the house manager and granted access. Maria Ana requested LPA check temperature on temperature reader affixed to the entry wall. Maria Ana monitored LPA's temperature and asked LPA to sign in. LPA observed staff #1 (S1) and 2 residents in the living area. LPA called the Administrator Daisy Hailey and notified Administrator reason for the visit. Administrator could not meet LPA and designated Maria Ana to sign this report. At 10:02 a.m. LPA and Maria Ana toured the physical plant of the facility, and the following was observed. Living room/ Dining area: The living room and dining area were clean and properly furnished. Fireplace not in use secured with a screen. Bedrooms: LPA inspected five (5) out of five (5) resident bedrooms. One (1) out of the five (5) bedrooms is a shared bedroom. LPA observed each private resident room to be properly furnished with one bed, appropriate night stand, chair, beddings and with sufficient lighting and storage. LPA observed an air mattress and twin bed in the shared bedroom. LPA asked Maria Ana who sleeps in the air mattress and Maria Ana indicated she sometimes sleeps in the shared room occupied by one resident when she is extremely tired. S1 immediately removed the air mattress. Bathrooms: The facility has three (3) bathrooms. LPA took water temperature from one (1) out three (3) bathrooms sink at 10:13 a.m. and temperature was 116.3 degrees Fahrenheit. LPA observed the bathrooms to be clean and properly supplied with toilet paper and trash bins with lids. Laundry/Garage: Laundry room leading to the garage and staff bedrooms is kept locked and inaccessible to residents. Detergents are kept locked in a the laundry room. At 10:17 a.m. LPA observed S1 test the hardwired, interconnected smoke detector located through out the facility. Detectors were observed to be functioning properly. LPA observed two carbon monoxide detector functioning properly. Maria Ana stated they have enough PPE to last more than 30 days. Kitchen/ Dinning area: The kitchen was observed to be clean and clear of clutter. Appliances and fixtures were functioning properly. LPA observed cleaning products kept locked under the kitchen sink. LPA observed knives locked in a kitchen drawer. LPA observed a sufficient amount of 2- day perishable and 7-day non-perishable food at the facility; properly stored. On a wall leading to the kitchen LPA observed one (1) fire extinguishers fully charged with a last serviced date of 05/19/2022. Dining area had appropriate table and chairs to sit the capacity of the facility. Medications : At 10:20 a.m. LPA observed centrally stored medications are maintained in a locked cabinet by the kitchen and living room. Medications were observed locked in the cabinet. One pharmacy is being utilized for two residents. Refills are either done automatically every 30 days, or ordered by the physician. Medication Records were reviewed for proper documentation. Medication records are maintained manually. Surrounding Grounds : Entry and exits were free of obstruction. There is a covered patio with appropriate furniture for clients to use At 10:30 a.m. LPA conducted interviews with three (3) out of three (3) residents and two (2) out of two (2) staff present. At 10:55 a.m. LPA interviewed Administrator by telephone and notified Administrator an Infection Control Plan was not on file for the facility. The licensee was granted a waiver under the Authority of Governor Newsom’s Executive Order N-11-22 issued on June 17, 2022, and the administrator agreed to submit the Infection Control Plan by June 12, 2023. Client/Staff Records: At approximately 12:15 p.m. three (3) out three (3) residents records and two (2) staff records were reviewed to insure compliance. Pursuant to Title 22 Division 6 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Exit Interview Conducted. Appeal rights provided. A Copy of the Report Issued.