Routine inspection·October 23, 2023

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Maldonado met with Care Manger, Victoria Serna, and explained the purpose for the visit. During today's visit, LPA Maldonado conducted a tour of the physical plant with Licensees, observed the facility food supplies, reviewed (4) resident files, and attempted to review (4) staff files. The facility is a single-story home, operating as an Residential Care Facility for the Elderly. It is licensed to serve (6) older adults, ages 60 and over. There is a fire clearance approved for (6) non-ambulatory residents, of which (1) may be bedridden, in room#4, only. There is a hospice waiver approved for (2). Currently, there is (1) resident on hospice. All resident bedrooms were inspected and had the required furniture, storage space, and lighting. Bathrooms were equipped with a toilet, wash basin, and showers. They were observed to have the required grab bars and non-skid mats. The water was tested and measured at 114*F in bathroom (BR)# 1, the water in BR#2 had a trickle of water coming out of the faucet when opened- in disrepair, and water in BR#3 did not have hot water. LPA and house manager left the hot water running for about 10 minutes, and the water did not turn hot. The food supplies was observed and had the required 2-day perishables and 7-day non-perishables. Fire extinguishers were observed throughout the premises, with current inspections and were fully charged. Walkways and ramps were observed to be free of debris and obstructions/hazards. Sharps were observed stored in the kitchen, inaccessible to residents in care. Toxins and cleaning supplies were observed stored in the laundry room and underneath the kitchen sink, locked and inaccessible to residents in care. Centrally stored medications were also observed stored inaccessible to residents. Auditory devices were observed at entrances/exits and operating properly. Sufficient linens, towels, and personal hygiene supplies were available. (Report Continued on LIC809-C...) The facility has an approved mitigation plan on file and a current infection control plan submitted to the department. Smoke/carbon monoxide detectors were observed in each room. The last fire drill was conducted on 8/30/23. Resident files were reviewed for required documentation, and observed to be complete. (3) of (4) staff files were reviewed and had the required documents. (1) staff file was unavailable to review at the facility during the time of the visit. At 2:05PM, LPA observed Staff#1's (S1) bed inside the kitchen area, separated by curtains. Per S1, S1 is a live-in staff and that is their room. Due to time constraints, LPA was unable to conclude the required Annual Inspection. The following domains are pending completion: Incidental Medical and Dental. Staff and Resident interviews are also pending to be conducted. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were observed and will be cited on the LIC809-D. An exit interview conducted with Care Manager and a copy of this report and appeal rights were provided.