Routine inspection·February 23, 2024

Licensing Program Analyst (LPAs) Valeria Conway and Kelly Dullek arrived at the facility at 9:10AM unannounced to conduct a required Annual visit. The last annual conducted at this facility was on 12/21/2022. The LPAs met with Staff to explain the reason for the visit. Administrator Arlene Ceballos and Izhak Illouz arrived at the facility shortly thereafter. The LPA’s toured the physical plant areas inside and outside, with Administrator Izhak Illouz at 9:40 A.M., to ensure there are no health and safety hazards. Last Emergency Drill (Fire and Earthquake) was done on 01/08/24. BEDROOMS: There are (6) six bedrooms designated for resident use, all resident bedrooms are private rooms and (1) one bedroom designated for staff use. Bedroom #3 and Bedroom #4 have a direct exit to the exterior. Bedroom #4 and #5 has a Jack and Jill bathroom. The facility has furnished each room with clean linens, nightstands, lamps, chests of drawers, chairs and closet space, and sufficient lighting for resident use. The bedrooms were large enough to allow for easy passage. RESTROOMS: Resident restrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. There are (4) four total bathrooms at the home. (2) Two are private bathrooms in Room #2 and #3. Restroom hot water measured 115.5 degrees Fahrenheit at 10:05 A.M. Continue on LIC 809C Continued from LIC 809 KITCHEN: Appliances in the kitchen were clean and all appeared functional. The facility has a sufficient supply of perishable and non-perishable food. Knives are stored in a locked cabinet and inaccessible in the kitchen as well as medications and chemicals. Appliances in the kitchen were clean and all appeared functional. Laundry and house cleaning supplies are stored in a locked cabinet under the kitchen sink and inside the outside garage. FILES: During today’s visit, the LPAs observed full bed rails on the bed of Resident #2. The Administrator stated that resident in room #2 is receiving hospice care services at the time of the visit. The Administrator provided bed-rail order. Staff file review revealed that Staff #1 (S1) and Staff #2 (S2) didn’t have health screening LIC503 nor TB Test negative results. COMMON SPACES: The common spaces included the living room and dining area. The LPAs observed cameras in all common spaces and a screened fireplace in the living room. All areas were clean, sanitary and in good repair. Smoke detector(s) and carbon monoxide detector were tested at 9:55 A.M. and operational at the time of the visit, they are hardwired and interconnected. The fire extinguishers were observed to be in compliance and last charged on 02/16/2024. The LPA's observed required postings on the wall leading to the kitchen. At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a working telephone on premises. Auditory alarms were functioning at the time of the visit. An adequate supply of emergency food and water was observed at the time of the visit. BACKYARD: The backyard has a covered outdoor area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. The facility has one (2) side gates that self-latches. No bodies of water noted at the time of the visit. Continued from LIC 809C Continued from 809C GARAGE: Is detached from the house and locked at all times. There is a freezer and a fridge full of extra food in it. LPA’s saw emergency water accessible laundry supplies, disinfectant, cleaning supplies and facility has a sufficient amount of Personal Protective Equipment (PPE) The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.