Routine inspection·November 17, 2023

On 11/17/2023 at 11:11 AM, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Caregivers Vanessa Vidanes and Edson Vidanes. LPA explained the purpose of today’s visit. Administrator/Licensee Rustico Punzalan and Licensee Ruby Punzalan arrived later and joined the visit. The facility is licensed to operate for six (6) residents ages range 60, six (6) non-ambulatory of which one (1) may be bedridden, hospice waiver for six (6). Currently, there are five residents. Three out of five residents are non-ambulatory, no bedridden and no hospice residents. The facility is a one-story house located in a residential neighborhood and consists of four (4) resident bedrooms, one (1) staff bedroom, two (2) bathrooms and a two car garage. The home also consists of a living room, dining room, and kitchen. At around 11:15 AM, LPA toured the physical plant with Caregiver Vanessa Vidanes. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 112.1 degrees F. A comfortable temperature of 76 degrees F. was maintained in the facility. LPA observed the facility to be 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 sufficient perishable and non-perishable food was maintained adequately. A fire extinguisher was charged. A review of the Medication Records Administration (MAR) was observed to be maintained in place. (Evaluation Report continues LIC 809-C) During the visit, 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. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone (424-378-1145) is operational. The last fire drill was conducted on 10/10/2023. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 7/12/23-7/12/24. The facility is current on Community Care Licensing annual dues. An audit of resident #1-#5 (R1-R5) service files and staff #1-#4 (S1-S4) personnel files revealed to be complete. Interviews were conducted with two residents and two staff. The facility has the current administrator's certification #6062032740 with expiration date of 1/14/2024. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed deficiency and issued a citation, deficiency is on the LIC 809D. An exit interview was conducted with Administrator Rustico Punzalan, and a copy of the report was provided.