Routine inspection·January 12, 2024

On 01/12/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with administrator and licensee Michelle Porca and explained the purpose of today’s visit. The facility is licensed to operate for six (6) non-ambulatory elderly residents ages 60 and above. The facility is approved for six (6) hospice residents. Currently, there are four (4) hospice residents in care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident's rooms, one (1) staff room, two (2) common bathrooms, a living area, a dining area, a kitchen, and an outside patio area. LPA toured the physical plant. There were no bodies of water or 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. The water temperature measured 109.6 degrees F. A comfortable temperature of 72 degrees F. was maintained in the facility. 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 extinguishers that were charged, smoke detectors, and carbon monoxide was operable. LPA reviewed Medication Administration Records (MAR) revealed accurate and maintained in order. The facility conducted a Fire/Safety Drill on 12/02/23. A working landline telephone remains available. The facility has a current liability insurance on file effective 06/23/23 – 06/23/24. Evaluation Report Continues on LIC 809-C During the visit, LPA observed the facility's infection control practices. LPA observed staff followed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). Posters mandated for inspection control were posted. An audit of residents #1-#6 service records and staff #1-#6 personnel records revealed to be completed. Interviews conducted with (1) resident. The facility is current on CCL annual dues. The facility has has a current CCL Administrator Certificate: #6031326735 Expiration - 03/25/25 for Michelle Porca. LPA observed staff #5 (S5) during file review had Criminal Clearance Background, but did not have a Criminal Clearance Transfer on file and (S5) did not appear on CCLD Guardian portal. Based on interviews, observation, and record reviews the licensee violated the California Code Regulations (CCR) of Title 22, Division 6, Chapter 8. Deficiency is issued and an exit interview is conducted with Michelle Porca. A copy of this report, appeal rights was provided.