Routine inspection·November 6, 2023

On 11/062023 at 8:50 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Robin Taporco, Licensee and Jerissa Bucu, Administrator . Six (6) residents and two (2) caregivers were present during this inspection. The facility is licensed to serve five (5) non-ambulatory residents and one (1) bedridden in room one. The facility also has an approved hospice waiver for four (4) residents. Two residents are receiving hospice services and two residents are receiving home health services. The home one floor and consists of: four (4) resident rooms, two (2) bathrooms, kitchen, dining room, living, indoor ramp, shaded patio and a laundry room near one of the bathrooms. 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 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 February 16, 2023 was observed in the kitchen area. LPA tested interconnected smoke detector throughout the facility. Devices are functional. A copy of the video surveillance addendum and updated facility sketch was reviewed. Six staff records were reviewed, six out of six staff records had required criminal record clearances. Training records were reviewed. Two staff members were interviewed. Five resident records were reviewed, and five out of five resident records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. Hospice and Home Health Records were reviewed. Two medication records were reviewed. Two residents were interviewed. At 9:30 AM LPA tested water temperatures in both bathrooms. The shower temperature in the bathroom across from room 2 measured at 121 degree F and the water basin at 123 degree F. The shower temperature near room 4 was measured at 122 degree F and the water basin at 122.3 degree F. LPA informed the Licensee and Administrator of the required temperature range (105 – 120 degree F) and an immediate on-site correction was made. Deficiencies are being cited based on LPA observation in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, technical assistance provided, and plan of correction was developed and reviewed with the Jerissa Bucu. A copy of this report and appeal rights were discussed and left with the Administrator.