Routine inspection·August 30, 2023

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Care Compliance and Regulatory Enforcement (CARE) Tool to evaluate the facility. LPA met with Direct Support Professional, Eadgitha Manala and explained the purpose for the visit. The facility is licensed to serve (6) elderly adults, ages 60 and over, of which (4) may be non-ambulatory, and (2) may be ambulatory. The facility is a single-story home, located in a residential area. The home consists of a living room, (4) residents bedrooms, (2) staff rooms, (2) resident bathrooms, a kitchen, dining room, living room, attached garage, and shaded patio with seating in the backyard. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incident Medical and Dental, Disaster Preparedness, and Emergency Intervention. During today's visit, LPA Maldonado obtained a copy of the client and staff roster, and conducted a tour of the physical plant with assistance of DSP, Eadgitha Manala. The following was observed: One central entry point for universal entry screening Mitigation Plan and Infection Control Plan approved and in place Sufficient PPE stored for 30-days and readily available for use, throughout the home and stored in the garage Physical plant inside and outside is clean, sanitary and in good repair All walkways and pathways observed to be free of obstruction/hazards All resident rooms inspected had the required furniture, bedding, linens, chair, adequate lighting, & closet space ( Report Continued on LIC809-C...) Each restroom is equipped with a toilet, shower, and wash basin Restrooms had the required grab bars and non-skid mats All kitchen and laundry equipment were clean and operational Water tested and measured at 114*F in bathroom# 1 and 113.7*F in bathroom# 2, which is in compliance Food was inspected and was sufficient for residents in care. Requirement met for 2-day perishables and 7-day non-perishables available One refrigerator inside the home and another freezer in the garage observed fully stocked with a variety of nutritious foods Kitchen cabinets and garage were observed with a variety of non-perishables including vegetables, proteins, cereals Emergency disaster plan, personal rights and complaint procedures are posted Smoke/Carbon monoxide detectors were tested and operating properly Fire extinguisher observed in the kitchen with a current inspection and was fully charged Working telephone for clients to use No bodies of water located on the premises Adequate seating in common areas for licensed capacity Cleaning supplies/toxins are stored in a locked under the kitchen sink, inaccessible to clients Sharps are stored in a kitchen cabinet, locked and inaccessible to clients (4) Client Files reviewed and observed to be complete with/but not limited to- current health screenings, appraisals, admission's agreements, personal rights, and emergency contact information (3) Staff files were reviewed and were complete with/but not limited to- fingerprint clearances, health screenings, and proof of required annual training Due to time constraints, LPA Maldonado was unable to complete the required annual inspection. LPA will return at a later time to complete it. Per California Code of Regulations, Title 22, no deficiencies were observed during today's visit. An exit interview was conducted with DSP Eadgitha Manalad, and a copy of this report was provided.