Routine inspection·December 28, 2023

On 12/28/2023 at around 8:20 AM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Licensee Vicenta Mendoza. LPA explained the purpose of the visit and was accompanied by the Licensee inside and outside the facility during this inspection. This facility is licensed to serve 6 adults ages 60 and above, of which 4 may be non-ambulatory residents. Facility must maintain a 24-hour awake staff. Facility is approved for 1 hospice resident. A total of 3 non-ambulatory residents are currently residing in this facility. The Annual Licensing Fees are current. The facility is a one-story house located in a residential street. The home consists of 3 resident bedrooms, 1 staff bedroom, 2 bathrooms, 1 dining/living room, 1 kitchen, 1 attached garage, and a front yard and backyard patio area with shaded seating. Outside grounds were toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to residents. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPA toured the kitchen area and observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept in locked storage cabinet. LPA observed that medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. Last Fire drill was conducted on 12/10/2023. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors were in compliance and operational. The fire extinguisher is in the kitchen area and was last serviced on 1/17/2023. There is a land line telephone in the living room area. There is a videoconferencing device (iPhone) dedicated for client use next to the land line telephone. LPA did not observe liability insurance for the facility. LPA observed several rust stains on the washer machine. LPA observed garage filled with clothing, boxes, furniture, miscellaneous supplies, etc. 3 out of 3 resident’s bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly, grab bars were secure, and a non-skid mats were in place. Adequate lighting and toiletries accessible to residents. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit. This facility provides residents with hygiene products such as feminine napkins, nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb. 5 staff records were reviewed, 5 out of 5 staff records had Criminal Record Clearances, Job Applications, Facility Drills, and signed Employee Rights. 2 out of 5 staff records did not have a Tuberculosis Test and 1 out of 5 staff records did not a Health Screening Report (LIC 503). 3 resident records were reviewed and, 3 out of 3 resident records had Admission Agreements, Medical Assessments, Consent Forms, Weight Record, Emergency Information, Tuberculosis Test, Centrally Stored Medication Destruction Record, and Personal Rights. 1 out of 3 resident records did not have an updated Appraisal & Needs Service Plan. Deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809Ds. A violation regarding Appraisal & Needs Service Plan; Tuberculosis Test & Health Screening Repots; Liability Insurance; clean, safe, sanitary and in good repair at all times. An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Administrator.