Routine inspection·September 9, 2024

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Rowena Marantal Carrillo - Administrator and explained the purpose for today’s visit. The facility is licensed to serve 6 Ambulatory Residents ages 60 and above, and a hospice waiver for (4). The facility currently has 2 residents on Hospice. The facility is a two-story home located in Downey, Ca. A tour of the facility includes: 1st floor: 2 resident bedrooms, 1 full bath, 1 1/2 bath, kitchen dining area, family room, living room, pantry, laundry room, closets, attached garage, front yard and back yard. 2nd (frontal) floor: 5 bedrooms (2 are resident rooms with private bath, 3 are staff rooms with bath), staff bath. 2nd (rear) floor: 2 staff bedrooms and 1 staff bath. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and the initial visit and observed the following: Infection Control: Staff are cleaning and disinfecting throughout the day and have an Infection Control Plan maintained at the facility. Operational Requirements: The facility has an approved fire clearance, there is a plan of operation with required Infection Control Plan and facility maintains the required liability insurance. Staffing : There appears to be sufficient staffing at all times in the facility. Personnel Records-Training : Staff has criminal record clearance, and ongoing training are documented in personnel files. LPA reviewed 4 staff files and 3 out of the 4 staff files reviewed were missing their first-aid certificates, citation will be detailed in the LIC809-D. Administrator Rowena Marantal Carrillo administrator certificate expires 6/24/2025. Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed 4 Resident Files with no issues observed. (Continued on LIC809-C) Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature was tested throughout the facility and measured within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked and are inaccessible to residents, however, during visit LPA observed a empty can of disinfectant in an unlocked cabinet in residents downstairs restroom, also Laundry room was observed to be unlocked with door open during visit making disinfectants/cleaning supplies accessible to residents. citation issued and detailed on LIC809-D. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. Last fire/disaster/earthquake drill was conducted on 9/1/24. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility has a variety of activities to choose from within the facility. There is an outdoor activity area available for the residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a closet and are in their original containers. LPA reviewed 4 residents’ medications during visit. LPA observed staffs personal medication/supplements in an unlocked kitchen cabinet along with medication cabinet being unlocked with key hanging from cabinet making medication accessible to residents, citation issued on LIC809-D. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. Residents with Special Health Needs: There are no bedridden or residents with postural supports at this facility. The facility currently has 2 residents on Hospice Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit will be detailed on the LIC809-D. Exit interview held and a copy of the report and appeal rights were provided to Rowena Marantal Carrillo.