Routine inspection·February 22, 2024

On 02/22/2024 8:54 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – Annual Inspection and met with Caregiver Renerose Seludo. Administrator Ethel Culala Monterroso joined us 30 minutes later. Six (6) residents and two (2) staff were present during this inspection. The facility is licensed to operate for six (6) non-ambulatory residents ages 60 and above. Facility is approved for one (1) bedridden (in room one or room three) and has a hospice wavier for four (4) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident's rooms, a staff room, two (2) bathrooms, living area, dining area, office area, kitchen, laundry area between the kitchen and hallway and (2) outside covered patio area with a table and chairs. There is an attached garage used for storage with access through the side of the house. Staff accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, last serviced October 11, 2023 was observed in the dining room area. LPA tested all carbon monoxide detectors and smoke detectors located throughout the home. Both devices were functional and interconnected . Continue to LIC 809-C. 5 staff records were reviewed, 5 out of 5 staff records had current first aid certificates. Two staff interviews were conducted. 5 resident records were reviewed and, 5 out of 5 client records had Medical Assessments. Two residents’ medication was reviewed. One resident was interviewed. Deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A violation regarding criminal record clearance warrants an immediate civil penalty of $500.00 and is hereby assessed, see LIC421BG. The Guardian roster searched on 02/21/24 did not show S3 associated to the facility and S3 was working on-site during LPA's 02/22/24 facility visit. Per Administrator, S3 started working on 02/09/24. On 02/22/24 2:25 PM, the Administrator emailed LPA Cloyd S3's criminal record transfer request, criminal record statement, and license. An exit interview was conducted, plans of corrections were developed and reviewed, and technical assistance was provided. A copy of this report and appeal rights were discussed and left with the Administrator Ethel Culala Monterroso.