Routine inspection·June 2, 2023

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Administrator Adlean Fisher-Ashley. The facility is licensed to serve 4 non-ambulatory residents ages 60 and older. The facility is a single-story home located in a residential. A tour of the facility includes: living room, dining room, kitchen, 2 client bedrooms, 1 staff room, 2 bathrooms, laundry room, attached garage, front yard, and backyard. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents’ medications. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan posted. Physical Plant & Environment Safety: There are 2 client bedrooms, 1 staff room, 2 bathrooms, living room, dining room, kitchen, attached garage, front yard, and backyard. Residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available and stored in the bathrooms. The hot water temperature was tested in both bathrooms and measured between 113.7 and 116.6 degrees F which is within the required range of 105-120 degrees. All storage areas for cleaning solutions, toxins, knives, and hazardous items are centrally stored and kept locked inaccessible to clients. During todays visit LPA observed cleaning supplies stored in an unlocked cabinet in resident bathroom and in laundry room which poses an immediate health and safety violation to residents in care. The last Fire/Emergency Drill was conducted on 06/2/23. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. (Continued on 809-C) Operational Requirements: There are currently 3 non-ambulatory residents residing at the facility. Staffing : There appears to be sufficient staffing at all times in the facility. Administrator Adlean Fisher-Ashley certificate expires on 05/23/24. Personnel Records-Training : Staff has criminal record clearance and current First Aid/CPR and sufficient on-going training. Staff files are maintained in a locked cabinet in staff room. Resident Rights-Information: Resident personal rights poster is posted in the dining room. Resident Records-Incident Reports: Resident files are kept locked in a file cabinet located in the staff room and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Planned Activities: There are sufficient activities readily available for residents in care. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: All medications for residents are kept locked in front closet and are inaccessible to other clients. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Residents with Special Needs: There are no residents who are bedridden or in need of postural supports in the facility. Per California Code of Regulations, Title 22, and California Health and Safety Code, deficiencies observed during today’s visit are documented on 809D. Exit interview was held, a copy of the report and appeal rights were provided to Administrator Adlean Fisher-Ashley.