Routine inspection·December 7, 2023

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on 12/27/2023. LPA was met by Caregiver MARIO MACALINO and explained the purpose of the visit. The facility is licensed to serve six (6) residents over the age of 60, of which six (6) may be non-ambulatory and approved hospice waiver for four (4). LPA OBSERVATIONS: The facility is a single-story dwelling located in a residential neighborhood and consist of three (3) resident bedrooms, one (1) staff bedroom, two (2) resident bathrooms, kitchen, dining room, living room, attached garage, staff office, front yard, and backyard. Front Yard: Front yard is well maintained, and no hazards were observed. Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to six (6) out of six (6) residents in care. Kitchen sink water temperature was measured at 137.2 degree F. LPA Ramirez observed chemicals and cleaning solutions, located in under kitchen cabinet, to be inaccessible to six (6) out of six (6) residents in care. Kitchen appliances were observed to be clean and in working order. LPA Ramirez observed Register of Facility Clients/Residents (LIC 9020) in clear plastic sleeve and was placed on kitchen cabinet. Dining Room/Living room/: Dining room was observed to contain one table with plenty of seating. Living room was observed to have plenty of seating and lighting. LPA Ramirez observed nearby thermostat in this area to read 77 degree F. Linen Closet: Contained plenty linens, towels, and hygiene products. Resident Rooms 2 - 4: LPA Ramirez inspected three (3) shared resident bedrooms and observed all bedrooms to contain required furnishings, lighting, and linens. LPA Ramirez observed proper signage indicating the use of oxygen in two (2) out of the five (5) bedrooms. LPA Ramirez observed “Bedside Checklist” placed in bedrooms #3 and 4 (near entry and in plain view) that contained confidential personal and medical information for three (3) out of the six (6) residents in care. See 809-C Bathroom: Bathroom#1 water temperature was measured at 141.1 degrees F. LPA Ramirez observed grab bars and non-slip mats. LPA Ramirez observed one (1) grooming razor in bathroom cabinet drawer. Bathroom#2 located in bedroom#4 was measured at 138.6 degree F. Backyard: No hazards were observed. Plenty of shade and seating was observed. Centrally Stored Medications: Medications were observed to be stored in facility hallway closet and inaccessible to six (6) out of six (6) residents in care. Emergency Drills: Last documented emergency drill was conducted on October of 2023. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Personnel Records: Personnel records are maintained at facility. LPA Ramirez reviewed staff files for three (3) staff. Documented proof of initial dementia training required within the first 4 weeks of employment was not observed for one (1) out of the three (3) personnel records reviewed. Resident Files: Six (6) resident files were reviewed. Liability Insurance & Infection Control Plan: LPA Ramirez obtained a copy of liability insurance. LPA Ramirez obtained a copy of Infection Control Plan. Deficiencies and technical advisories are being cited. A copy of this report, 809-D, LIC 9120 and appeals rights was provided.