Routine inspection·October 3, 2023

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Assistant Administrator Danielle Maximo. Administrator Rose Maximo arrived later. There are currently 4 developmentally disabled residents 60 years and older residing in the facility. None of the residents are receiving hospice care, home health, or have Dementia. The inspection was completed using the CARE tools. Twelve (12) CARE tools domains were reviewed. Infection Control: Visitors are no longer being screened for COVID-19, but are still required to sign in. The facility has an Infection Control Plan and Covid-19 Mitigation Plan. Infection control practices and Personal Protective Equipment (PPEs) were observed. Operational Requirements: A current Plan of Operation was reviewed. The facility has a Dementia Waiver in place. A Hospice Waiver for 4 is approved. A fire clearance for 6 non-ambulatory adults 60 and over is in place. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current. Facility handles resident's P & I monies. A Surety Bond of $2,000 is current. ***See next page for report narrative.*** Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood consisting of 4 private resident bedrooms, 2 bathrooms, living room, dining room/kitchen, outdoor patio area with patio furniture, and 2 car detached garage with laundry area. 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. Kitchen drawers containing knives/sharp objects were locked. The facility has one (1) fully charged fire extinguisher and a fire pull alarm. Auditory alarms in bedrooms with exterior exit doors are operable. Water temperature readings did not measure within the required 105 - 120 degrees Fahrenheit. Bathrooms hot wat er measured 123.1 & 122.6 Degrees Fahrenheit. Citation was issued. Staffing: A total of 7 staff provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expired 7/10/2022. Licensee/Administrator provided proof that training was submitted to certification unit and is awaiting receipt of current certificate. Personnel files were reviewed. Criminal Background Clearance, staff training, 1st Aid/CPR, and health screening/TB clearance was checked. Resident Records/Incident Reports: A total of four (4) resident files were reviewed. All required documents were observed. RCFE complaint poster and Personal rights were observed posted in the facility. ***narrative continues next page*** Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Indoor and outdoor activities are performed, as well as community outings. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician orders for modified diets are in place. One (1) resident has a puree diet. Incident Medical and Dental: Medication Administration Records (MARs) and resident medications were reviewed. PRN medications were not listed on the MAR, but MD orders are in place. Administrator was advised to contact pharmacy so they can add the PRN medications to the MAR. Medical and dental transportation is provided by facility staff. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. The last emergency disaster drill was conducted on 9/22/2023. Residents with Special Health Needs: No residents currently receive hospice or home health care. No resident beds have bed rails.. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Administrator Rose Maximo. A copy of the report and appeal rights were issued.