Routine inspection·September 12, 2024

Licensing Program Analyst (LPA) S Vaid conducted an annual required visit. LPA met with caregiver, Tita Bartolata and explained the reason for the visit. Caregiver Tita Bartolata, called Administrator, Administrator joined shortly after. LPA used the CARE tool to evaluate the facility. LPA inspected the physical plant, reviewed residents' medications, observed food supply, and reviewed resident and staff files. Facility has submitted a mitigation plan and the plan has been approved. The facility consists of (5) bedrooms, of which (1) is for live-in staff, (3) bathrooms of which (1) is for live-in staff, a living room, kitchen, dining room, TV room, shaded patio in the backyard and a detached garage. All resident bedrooms were toured and observed to have a smoke detector, the required furniture, linens, and sufficient closet and storage space. All bathrooms were observed to have a toilet, shower, and wash basin. The resident bathrooms were observed to have the required non-skid mats and grab bars. The bathroom basins with Jack and Jill sinks read 131.7degrees F which is not within the required 105 - 120 degrees- noted. The kitchen was toured. All appliances were operating properly. There was a sufficient amount of 2-day perishable and 7-day non-perishable food, and the refrigerator in the garage. The common areas including the living rooms and dining room are clean and have the required furniture. The backyard has a shaded area and sitting area. The facility has cameras in the hallway and common areas, for surveillance only, not recording. LPA observed a cabinet near the entrance of the laundry room to the right, that stored cleaning supplies/toxins and laundry supplies. Toxins and sharps are inaccessible to the residents. LPA reviewed all resident files. Residents’ admission agreement, pre-admission appraisal, and proof of TB test. LPA reviewed staff files. Staff files contain health screening report, fingerprint clearance, certificates and trainings. LPA reviewed 4 residents' medications. Medications are documented properly and given as prescribed. First aid kit was observed and has all the required items and manual. Continued on 809C Per California Code of Regulations, Title 22, the deficiencies observed are documented on the attached LIC809-D. An exit interview was conducted, and a copy of the report, LIC 809, LIC 809C and LIC 809D and appeal rights were provided to Administrator.