Routine inspection·October 12, 2023

On 10/12/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Caregivers Letecia Barber and Susan Adeva and explained the purpose of the visit. At around 11:00 AM, Administrator Marylou Namoc arrived and joined the visit. The facility is licensed to operate for six (6) non-ambulatory elderly residents ages 60 and above. The facility is approved for one (1) bedridden and two (2) hospice. The facility is a single-story structure located in a residential neighborhood. The facility consists of the following: five (5) resident's rooms, two (2) bathrooms, a living room area, dining area, and kitchen. There is an attached garage with access through the door prior to entering the facility or the garage door. The washer and dryer are located in the garage. There is a shaded patio area with ample seating area for the residents. The facility does not handle residents’ cash resources. Facility Annual Fees are current during today’s visit. Administrator's certificate expires 6/25/2024. At around 10:00 AM, LPA toured the inside and outside grounds of the facility with Caregiver Letecia Barber and Marylou Namoc. Carbon monoxide and smoke detectors were tested and found to be operable. Fire extinguishers were last serviced on 7/5/2023. The last facility fire drill was on May 20, 2023. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, and toxins were stored and not accessible to clients. The kitchen was inspected and there are sufficient two-day perishable and seven-day non-perishable food supplies. There are no pools or bodies of water on the premises. There are no firearms on the premises or other dangerous weapons. Centrally stored medications are locked in a cabinet located in the medication room. The first aid kit has all required supplies. The facility has a written emergency disaster plan posted in the living room. The facility is maintained at a comfortable temperature. LPA observed the hot water temperature in the common bathroom was 116.1 degrees Fahrenheit. There are working lights or lamps in each room at the time of visit. There are grab bars for each toilet and shower used by residents. Showers have non-skid floors. Report Continued in LIC 809-C LPA requested a copy of the facility's liability insurance certificate. Administrator will email the binder. LPA observed the following deficiencies: 1. LPA Lourdes Montoya observed a caregiver (S3) is not associated to the facility. The administrator verbally confirmed S3 is not associated to the facility. S3 stated S3 began working at the facility in September 2023. 2. At around 10:08 AM, LPA Lourdes Montoya observed expired hamburger buns, Kroeger soft wheat bread, hotdog buns and guerrero tortillas inside the pantry. The hamburger buns expired on 9/21/23. The Kroeger soft wheat bread expired on October 6, 2023. The hotdog buns expired on 9/17/23. And the Guerrero tortillas expired on May 12, 2023 Deficiencies are being cited based on LPA observations, interviews conducted and records review in accordance with the California Code of Regulations, Title 22, see LIC809D. Civil penalty is being assessed. An exit interview was conducted, Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left wit Administrator Marylou Namoc.