Routine inspection·November 7, 2024

At approximately 9:35AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Staff Members, Loida Paningbaatan and Cristostomo Nario . Designated Representative, Bella Nachor, arrived during visit at approximately 10:10AM. Licensee, Ana Belle Bautista, arrived during visit at approximately 10:20AM. 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 3 individuals. Upon arrival, LPA was informed that there were 6 residents in care and 2 staff members on-site. At approximately 9:45AM, 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 9:50AM, LPA conducted a walk-though of the facility with Staff Member. 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, a staff room, 3 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. Hot water temperatures for sinks in facility were found to be at the following temperatures, 120.5F, 116.6F, 113.3F, and 123.4F. LPA observed that facility has signage stating that hot water temperatures may exceed 125F and to use caution. Fire extinguishers were last inspected June 2024. Smoke detectors and carbon monoxide detectors were tested and operational. Facility's last emergency/disaster drill was conducted June 2024 (technical violation issued, LIC9102, H&S Code 1569.695(c)). During walkthrough, LPA observed two Lysol disinfectant sprays in a resident's bathroom. Lysol was removed from resident's bathroom and was locked inaccessible (deficiency cited, LIC809D, regulation 87705(f)(2)). At approximately 11:00AM, LPA reviewed staff files, resident files and resident medication. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. Medication was observed to be centrally stored and secure. Continued on LIC809C Continued from LIC809 Administrator's Certificate for Ana Belle Bautistia (7000300740) was current with an expiration date of 3/12/2025. LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610E) Updated Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Updated Liability Insurance Active and Current Administrator Certificate Documents to be submitted to Community Care Licensing (CCL) by due date of 12/07/2024. 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, LIC809D (Deficiency Page), LIC9102 (Technical Advisory/Violation), Plan of Corrections, and Appeal Rights discussed and provided to Designated Representative. Signature on form confirms receipt of documents.