Routine inspection·January 16, 2025

On 01/16/2025, The Department of Social Services, Community Care Licensing Division (CCLD) staff conducted an unannounced annual required visit using the CARE Inspection Tool. CCLD staff met with staff one, Hannah Gitau Caregiver (S1) and CCLD staff explained the purpose of the visit. The facility is licensed to serve (6) residents ages 60 and above. All rooms have fire clearance for bedridden residents. Approved hospice waiver for (6). This is a single-story home consisting of: four (4) resident bedrooms ( Bedrooms #1, #2, #3 are single occupancy with full size beds Bedroom #4 is a shared room ) , one (1) staff room, two (2) bathrooms, one (1) living room, one (1) kitchen with dining area, outdoor shaded patio located in the back yard area, an attached garage along with washer and dryer located outside the garage. The front yard has adequate shaded area with seating and has an enclosed fence. CCLD toured the physical plant with Caregiver, S1. There are no bodies of water or obstructions on the premises. A total of four (4) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bathroom #1 was measured at 117.1°F and Bathroom #2 was measured at 110.1°F, all water sources in the house were observed to be fully operational, without mold, and within Title 22 regulations. CCLD inspected the smoke detectors and determined they were in operable condition. Carbon monoxide / smoke detector combo was located in the garage, above the entrance to the garage from the staff room, and was not in operational condition. Please see LIC809-D. Evaluation Report Continues, see LIC 809-C. CCLD staff observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharp objects were observed and not accessible to residents. The kitchen was inspected and there is sufficient 2-days perishable and 7-days non-perishable food available, on-site, and the food(s) were properly stored. All fire extinguishers were charged and were operable. A review of (3) residents' service files and (3) Medication Administration Records (MAR) was conducted. All three (3) residents have not visited their physician since the year of 2022 and all three (3) residents have been marked as having "Mild Cognitive Impairment" (MCI). CCLD has requested that all four (4) residents have an updated physician's report from the year of 2025, please see LIC809-D. One error was noted in the MAR for one resident (R1). S1 confirmed the medication (M1) has been provided to R1 three (3) times (3x) per day. R1 confirmed with CCLD that they receive M1 3x per day. CCLD cited this deficiency as a technical violation, please see LIC9102-TV. One resident's (R2) documents were unable to be located, please see LIC809-D. All staff paperwork was not available to be reviewed, please see LIC809-D. CCLD reviewed first-aid kit, and was observed to be fully stocked. . LPA observed the facility's infection control practices, which has met CCLD requirements. A copy of the liability insurance was not provided, please see LIC809-D. Four (4) deficiencies have been cited during today's visit, please see LIC809-D. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), CCLD observed four (4) deficiencies during today's visit, please see LIC809-D. An exit interview was conducted with caregiver, Hannah Gitau (S1). A copy of the appeal rights, this facility evaluation report and four (4) deficiencies were provided.