Routine inspection·June 4, 2021

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with Administrator Teodora Manahan and explained the reason for the visit. Physical Plant was toured, sample record of medications were reviewed, and food supply was inspected. The following were observed/inspected: LPA and Ms. Manahan toured the home and inspected (4) client bedrooms, (1) staff bedroom, (2) bathrooms, kitchen, dining room, living room, family room, and detached garage. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the clients located in the backyard. Passageways and exits are free of obstruction. The water temperature was tested in bathroom #1 and measured at 113.5F which is within the required 105 - 120 degrees. Clients bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Clients beds have the required linen and the linen is in good condition. Smoke detectors were observed throughout the facility and were tested and operable during the visit. There is a carbon monoxide detector in the living room area of the home. There is a fire extinguisher located in the kitchen and it is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in a kitchen drawer and are inaccessible to clients. Cleaning supplies and toxins are locked in a kitchen cabinet and are inaccessible to clients. First Aid kit was fully stocked with current manual. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed. (3) out of the (4) client medications were reviewed. LPA did not observe accurate, current, records of centrally stored medications for the residents. LPA also observed Resident #1 had medication that was not stored in its original container. Staff and Client files were not reviewed during today's visit. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on 809D. Exit interview held and a copy of the report along with appeal rights were provided.