Routine inspection·January 29, 2025

On 01/29/2025, Licensing Program Analysts (LPAs) M Vega and L Salazar conducted a required unannounced Annual Inspection visit. LPAs introduced self, stated purpose of visit, and allowed entrance by staff. Administrator Jasmin Burns was contacted however was not able to attend. Spoke with House Manager – Myra Torres. LPAs observed interior of the facility to be clutter free, exits to be free from obstruction, and odor free. LPA observed 3 residents sitting at the living room and a few others in their rooms. LPAs toured the facility inside and out to include entry, kitchen, dining, living room, bedrooms, bathrooms. Facility was observed to have dust build up in vents and walls. All fire exit routes were free and clear of obstructions. Exterior walkways were observed to have a hose across the walkway obstructing the path. Uneven pavement was also observed which could present a tripping hazard to residents. Carbon monoxide detector was tested and in working condition. Water temperature was checked in bathrooms 5 and read at 96-degree Fahrenheit, kitchen sink read at 104.9-degree Fahrenheit and bedroom 9 sink read at 131.2 degree Fahrenheit. Continuation on LIC 809C LPAs reviewed a sample of employee records which were missing current training verification. LPA reviewed resident files which were not current or up to date. Resident records are were observed to be the wrong physicians report form (LIC 602), not the RCFE physician report (LIC602a), however, house manager is scheduling appointments this week to obtain the correct forms. Files also have missing documents and files that are not up to date, Medications are stored in a locked cart the office. Exit interview was conducted and a copy of this report LIC809, Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 809-D. An immediate Civil Penalty in the amount of $500 is being assessed for fire clearance violation. 3 out of 11 residents were observed to not be able to turn without assistance. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal rights of the residents in care. An exit interview was conducted with House Manager. A copy of this report and appeal rights were discussed and provided at the time of visit. Obtained permission from administrator for House manager Myra to sign forms.