Routine inspection·June 13, 2024

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 10:30 a.m., the LPA met with staff and explained the reason for the visit. At 11:14 a.m., the Licensee, Carrie Acosta arrived at the facility. At 11:11 a.m., the LPA, along with staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards. KITCHEN: The LPA observed the kitchen/dining area. Knives and cleaning supplies are stored inaccessible. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:13 a.m., hot water measured at 105.2-degree Fahrenheit. Laundry units are located next to the kitchen in the laundry room. BEDROOMS: The facility is a single-story residential home with four (4) bedrooms, three (3) for resident's use and one (1) for staff. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. During the tour, the LPA observed Resident #1 (R1), who is bedridden not residing in the bedridden room. The LPA held a conversation with the Licensee regarding the importance of following the facilities fire clearance. RESTROOMS: The facility has two (2) bathrooms, one (1) for resident use and one (1) for staff use. Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 11:24 a.m., hot water measured at 105.1-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Continued on LIC 809-C. OUTDOOR SPACE: At 11:30 a.m., the LPA observed the back patio which has a covered outdoor area for resident use. The property is gated. There are no bodies of water on the premises. There are two (2) locked sheds in the back patio that is used for storage. The garage is detached to the house and remains inaccessible to residents. The garage contains additional food and cleaning supplies. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 10/30/2023. At 12:00 p.m., fire alarms/ carbon monoxide detectors were tested and functioned properly. Medications are centrally stored and locked in a cabinet in the dining room area. RECORD REVIEWS: Between 11:41 a.m. and 12:56 p.m., the LPA conducted a file review for all residents and staff regularly scheduled. Staff records were reviewed for documents including, but not limited to health screening, TB test, and fingerprint clearance. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. The following was noted: Four (4) out of five (5) residents require updated appraisals/needs and service plan, technical violation issued. Two (2) out of three (3) residents diagnosed with dementia need annual medical assessments, citation issued. Due to time constraints the LPA will return to complete the annual at a later date. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8 and California Health and Safety Code the following deficiencies were cited (refer to LIC 809-D). Civil penalty in the amount of $500 was assessed. Exit interview conducted. A copy of the report and appeal rights was provided.