Routine inspection·February 22, 2024

At approximately 9:50AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Licensee/Administrator, Silvana Daniel. Administrator, Steven Daniel, arrived to facility at approximately 11:00AM. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and capacity for 6 non-ambulatory residents. Facility has an approved hospice waiver for 2 individuals. Upon arrival, LPA was informed that there were 4 Residents in care and 1 staff member on-site. At approximately 10:00AM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 10:15AM, LPA conducted a walk-though of the facility with Licensee/Administrator. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a 1 story building with 5 Resident bedrooms, 1 staff bedroom, 4 bathrooms, and common spaces. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. LPA reviewed staff files, resident files and resident medications. Files were all found to be well organized and thorough. Staff files had current First Aid and CPR certification. During Resident File Review, LPA observed that 2 residents did not have updated Physician Reports or Service Plans (This deficiency has been cited, see LIC809D, Regulation 87458(b)(1)). Medication was centrally stored and secure. During Medication Review, LPA observed that the facility has been pre-pouring medication for one resident. LPA notified facility that pre-pouring medications is against regulation (See Technical Violation, LIC9102, Regulation 87465(h)(5)). Licensee's Administrator's Certificate (6003231740) is current with an expiration date of 03/21/2025. Continued on LIC809C Continued from LIC809 Facility's fire extinguisher was last inspected November 2023. Facility smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency drill was conducted December 2023. LPA is requesting the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610D) Updated Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Updated Liability Insurance Facility Documents to be submitted to Community Care Licensing (CCL) by due date of Thursday, 03/22/2024. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D (Deficiency Page), LIC9102 (Technical Advisory/Violation), Plan of Corrections, and Appeal Rights discussed and provided to Licensee/Administrator. Signature on form confirms receipt of documents.