Routine inspection·July 26, 2024

On 07/26/24, Licensing Program Analysts (LPAs) Ernand Dabuet and Hollie Enriquez conducted an unannounced annual required visit using the CARE Inspection Tool. LPAs met with administrator and owner Leslie Bauguess and Darwin Padolina explained the purpose of today’s visit. The facility is licensed to operate for six (6) elderly residents of which (5)) may be non-ambulatory. The facility is approved for (4) hospice residents. Currently, the facility has (1) resident in hospice care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident's rooms, two (2) common bathrooms, one (1) staff bedroom, (1) staff bathroom, a living area, a dining area, a kitchen, and an outside covered patio area. LPAs 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 107.9 degree F. A comfortable temperature of 73 degree F. was maintained in the facility. LPAs 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. Fire extinguisher was charged, smoke detectors and carbon monoxide were operable. A review of the Medication Administration Record (MAR) was complete and accurate. A landline telephone was in working condition. Evaluation Report Continues LIC 809-C During the visit, LPAs observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPAs observed the facility has a supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPAs observed First Aid Kit was maintained. The facility has current liability insurance on file effective 03/01/24 - 03/01/25. The facility is current on Community Care Licensing annual dues. An audit of residents #1-#5 (R1-R5) service files and staff #1-#5 (S1-S5) personnel files revealed to be complete. The facility has a current Administrators Certificate for Leslie Bauguess #6052747740 Exp. 05/17/25. Deficiencies: During audit of personnel records staff #2, did not have Health Screening LIC 503 on file along with TB test results. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 9099-D). An exit interview conducted with Leslie Bauguess and a copy of report and appeal rights provided. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *