Routine inspection·June 23, 2023

On 6/23/2023, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required using the CARE Inspection Tool. LPA met with Nelly Drugan/Caregiver. LPA explained the purpose of today’s visit. The facility is licensed to serve (6) residents ages 60 and above. (5) non-ambulatory and (1) bed ridden. Facility has a waiver for (2) hospice patients. The facility is a single-story structure located in a residential neighborhood. It consists of the following: kitchen, (6) private bedrooms for residents; (1) staff room; (4) bathrooms including a separate shower room for residents; living room, Dining room; washer and dryer area; attached garage and backyard shaded area. LPA Iniguez observed the facility to be free of odor. LPA Iniguez toured the physical plant with caregiver. There were no bodies of water or obstructions on the premises. A total of (3) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected rooms: #1, #2, and #3 and smoke and carbon monoxide are all in operable conditions. The water temperature properly measured between 105°-120°F: Kitchen 116’7°F, Bathroom #1:113.5°F & Bathroom #2: 116.3°F. The room temperature ranged from 76F° – 78F°. Evaluation Report Continues LIC 809-C LPA Iniguez observed the facility to be sanitary and appropriately furnished at the time of the 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. All fire extinguishers were charged and were operable. Working landline phones are available on-site. A review of (3) residents' service files (R1-R3)-(see D page for deficiencies) and (3) staff personnel files (S1-S3) and Medication Administration Records (MAR) were maintained in order. First AID kit was checked. LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. See D pages for citations. Exit interview conducted with Nelly Drugan/Caregiver and a copy of the appeal rights were given at the time of the visit.