Routine inspection·October 9, 2023

On 10/09/23 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA was greeted by the Administrator Jozam Batuian. LPA observed covid-19 signs at the front door and required postings were observed in the entry area. LPA Rios explained the purpose of the visit. At 10:10 a.m. LPA and administrator Jozam conducted a physical plant tour to ensure the health and safety of the residents in care. The following was observed: Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of 2-day perishable and 7-day non-perishable food at the facility; properly stored. Knives were stored in a locked cabinet in the kitchen. Bedrooms: There were six (6) bedrooms of which four (4) are designated for residents' use. Three of the bedrooms are currently occupied. One (1) room is currently vacant. Rooms occupied by residents were properly furnished with appropriate beddings and linens with sufficient lighting. A hallway closet by the bedroom was observed to store extra linens. Bathrooms: There are three (3) bathrooms. Two (2) are designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was taken from one (1) of two (2) bathrooms at 11:48 a.m. and read 110.6 degrees Fahrenheit. Common Areas : These included the living area and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. (Continued on LIC809-C) The smoke alarms are dual carbon monoxide detectors they are hired wired and interconnected. Administrator tested smoke/carbon detectors at 12:00 p.m. and were observed to be functioning properly. The fire extinguisher is located in the kitchen and the laundry room with purchase date 08/22/23. Surrounding Grounds : Entry/exits were free of obstruction. The outdoor area was free of hazards and has a covered patio with outdoor furniture. LPA observed a shed used for storage. The laundry room leads to the garage and is kept locked and inaccessible to residents in care. Detergents and cleaning products are kept in the laundry room locked. Resident Files : LPA conducted a file review of resident records to insure compliance of licensing forms at 12:10 p.m. Staff Files : LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms at 12:47 p.m. Medications : Medication and Medication Records were reviewed for proper documentation. LPA review of Centrally Stored Medication and Destruction Records (CSMDR) for two (2) of two (2) residents revealed medication dosages were inaccurate for both residents. According to administrator medication dosage taken had been updated but he had not had a chance to update the dosage on CSDMR. LPA observed Destruction log record was missing for medication indicated discontinued on (CSMDR). Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiency observed during the visit. Exit Interview Conducted. Appeal Rights provided. A copy of the report Issued.