Routine inspection·March 8, 2023

On 03/08/2023, Licensing Program Analysts (LPAs) Lizeth Villegas, Felisa Shirley and LPM Janae Hammond conducted an unannounced annual required visit using the CARE Inspection Tool. LPAs met with administrator Vergal Agatep and explained the purpose of today’s visit. The facility is licensed to operate for six(6) non-ambulatory/ambulatory residents ages 60 and above. Facility may retain three (3)hospice residents. The facility is a single-story structure located in a residential neighborhood. Facility consists of the following: four (4) resident's rooms, one (1) staff bedroom, one (1) common bathroom, two (2) private bathrooms and one (1) private half bathroom in room five (5), a living area, dining area, kitchen, outside covered patio area and an attached garage. LPAs and administrator toured the physical plant, there were no obstructions on the premises. All rooms were inspected; beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational, water temperatures measured 111 F to 114 F. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. The facility has two (2) fire extinguisher that were charged, smoke detectors, and carbon monoxide were operable. LPA Villegas reviewed Medication Administration Records (MAR) which revealed to be accurate and maintained in order. A working landline is operable with (1) one cordless telephone in the living room and (1) one cordless telephone located in the kitchen. During todays visit the following deficiencies were observed: · LPA observed auditory alarms in rooms one (1), two (2) and five (5) were not operational at the time of visit · LPA observed small roach in kitchen cabinet · LPAs reviewed 3 of 3 residents records and all three records were incomplete, resident number one (1) was missing pre appraisal, needs for service plan and blank consent forms. Resident two (2) had blank consent form, needs for service plan. Resident three (3) was missing pre appraisal, needs for service plan and blank consent forms · LPA reviewed resident number three (3) and did not observed physician orders for half bed rails · LPA reviewed fire drill log and was informed by administrator that the last fire drill was conducted in 2020 Advisory Notes - Technical Assistance was issued, please see LIC9102-AN. Deficiencies cited under California Code of Regulations title 22, division 6, chapter 8 are being cited on the attached LIC 809 D An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Vergal Agatep.