Routine inspection·August 10, 2023

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Jaime Villaflores who is a Caregiver and Assistant Administrator of the facility. The administrator Joy Villaflores arrived shortly thereafter. There are five (5) residents who reside within the facility. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control practices and Personal Protective Equipment (PPEs) were observed. Administrator advised she will send a completed Infection Control Plan within 7 days. Physical Plant/Environment Safety: · The facility is a single-story house located in a residential neighborhood. It is licensed for a capacity of six (6) residents, four (4) of which may be non-ambulatory and they also have a hospice waiver for one (1). It five (5) client rooms, a dining room, a kitchen, a private restroom (R1) connected with Bedroom #5 whose hot water temperature measured at 113.5 Degrees F, and a shared client Restroom (R2) whose hot water temperature measured at 115.8 Degrees F, a front and back yard patio area which held a storage shed and the facility’s washing and drying machines, and an attached garage which held the facility’s emergency food supply and cleaning supplies. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. The facility has one (1) fully charged fire extinguisher located near the kitchen of the facility. · Water temperature readings measured between the required 105 - 120 degrees Fahrenheit. Operational Requirements: · The Program Design was reviewed. · Fire clearance was approved by LA County Fire Department for six (6) residents, four (4) of whom may be non-ambulatory and a hospice waiver approved for one (1). · Care and supervision to meet the clients’ needs was observed. Staffing: · A total of eight (8) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Five (5) staff files were reviewed for criminal background clearance and training. · Personnel records have health/TB screenings, CPI training, certifications, and 1st Aid/CPR training, however the 1st Aid/CPR training is out of date and expired on 2/7/2023 for 2 staff members. Client Rights/Information: · Physician orders were reviewed in client files. Client Records/Incident Reports: · Five (5) client files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. · No restricted Health Care plan required for the clients in the facility. Incident Medical and Dental: · All clients have a Needs and Services Plan, and COVID-19 vaccination cards on file. · Staff training was on file. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit is documented on the LIC809D. Exit interview held and a copy of the report along with appeal rights were provided.