Routine inspection·December 14, 2024

On 12/14/2024 around 9:20 AM, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD) staff conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Administrator/Licensee, Renee Faulkner. CCLD staff explained the purpose of the visit and was accompanied by a staff member inside and outside the facility during this inspection. This facility is licensed to serve 5 ambulatory adults ages 55 and above, of which 2 maybe on hospice. A total of 3 residents are currently residing in this facility. The Annual Licensing Fees are current. Facility Layout: The facility is a one-story house located on a main residential street. The home consists of 4 resident bedrooms, 1 full bathroom, 1 toilet room, 1 kitchen area, 1 laundry area, 1 living room area, 1 community room area with a dinning table, office area, and activity table, 1 backyard area with a table and seats, and 1 attached garage. Outside Grounds: were toured no bodies of water were observed, walkways around the home were clear of hazards, and there are security bars on the back windows but not on the resident bedroom windows. Kitchen Area/Facility Food: The facility has supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives were kept inaccessible to residents in care. There is fire extinguisher in the kitchen area. Living Room/Community Room: There is a landline telephone, videoconferencing device, and games/activity work (i.e puzzles) for residents in the community room area. There are sofas and a large television in the living room. Resident Bedrooms: 4 out of 4 resident bedrooms were toured. There is adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Bathrooms: Toilets, showers, and water faucets worked, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. Medications: were inaccessible to residents in care. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. 3 out of 3 Medication Administration Records (MARs) were reviewed and they were current and up to date. Miscellaneous: Documents are posted as mandated. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors were in compliance and operational. The last Disaster Drill was conducted on 01/30/2023. 5 staff records were reviewed, 5 out of 5 staff records had required documentation. 3 resident records were reviewed and, 3 out 3 resident records did not have their Tuberculosis Test Results and 1 out of 3 resident records did not have their Physicians Report (Physical Exam). A technical advisor is being provided regarding removing facility small refrigerator and facility file cabinet from a resident’s bedroom. The licensee has agreed to find a new place for the items. A deficiency is being cited based on record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A violation regarding resident records. An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Licensee.