Routine inspection·September 23, 2024

On 09/23/24 Licensing Program Analysts (LPAs) Angelica Segovia and Evelin Rios arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPAs were greeted by the Administrator Jozam Batuian. LPA observed required postings along the entry walls. LPA explained the purpose of the visit. This is a single story home with six (6) bedrooms and two (2) and a half bathrooms. The facility has an approved fire clearance for five (5) non ambulatory and one (1) bedridden resident with a total capacity of six (6) and hospice wavier for 6. At 11:35 a.m. LPAs and administrator Jozam conducted a physical plant tour and 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 under the sink. Cleaning solutions and poisons where also locked in the cabinet under the sink. One (1) fire extinguisher was in the kitchen fully charged. Bedrooms: There were six (6) bedrooms of which three (3) are currently designated for residents' use. Three of the bedrooms are currently occupied. Bedrooms 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 and was at a comfortable temperature. . (Continued on LIC809-C) 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. The smoke alarms are dual carbon monoxide detectors and are hard wired and interconnected. Administrator tested smoke/carbon detectors at 12:05 p.m. and were observed to be functioning properly. 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 and Staff Files : LPA conducted a file review of resident records to insure compliance of licensing forms at 12:15 p.m. LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms at 12:46 p.m. Medications : Medication and Medication Records were reviewed for proper documentation. LPA review of Centrally Stored Medication and Destruction Records (CSMDR) for three (3) of three (3) residents revealed PRN (as needed) medications were not documented in three (3) of three (3) resident records as being given when they were. Review of three (3) residents' physician's reports revealed residents are unable to determine their own need for a prescription or nonprescription PRN medication, and are unable to communicate their symptoms clearly . According to the administrator they did not document every time an as needed medication was provided. 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.