Routine inspection·November 3, 2023

On 11/3/2023, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required using the CARE Inspection Tool. LPA met with Shymmi Bayar/Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (6) residents ages 60 and above. (6) non-ambulatory and (1) bed ridden. The facility has a waiver for (3) hospice patients. Bedroom #3 is approved for bedridden. Facility is a 1-story house located in a residential neighborhood. The facility has 6 resident-bedrooms. Upon entry, there is a foyer, kitchen to the left, living room, and dining room to the right. Through the hallway on the right is bedroom #1, a bathroom, storage and bedroom #3. On the right is 1 bathroom, bedroom #2 and #4, laundry room, bedroom #5, #6 and an additional bathroom. There is a 1-car garage, with a long driveway. There is a large backyard with a sitting area adjacent to the house. LPA Iniguez toured the physical plant with staff. There were no bodies of water or obstructions on the premises. A total of (4) 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, #3, and #4 and smoke and carbon monoxide combo are all operable conditions. The water temperature properly measured between 105°-120°F: Kitchen 111.6°F, Bathroom #1:106.3°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, 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 and (3) staff personnel files 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. Fire/disaster drill performed on:10/3/2023. Administrator provided a copy of liability insurance to LPA during visit. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. (See D Pages) Exit interview conducted with Shimmon Bayar/Administrator and a copy of the appeal rights were given at the time of the visit.