Routine inspection·November 9, 2022

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Administrator Rodrigo Fontejon, Continual Administrator's Certification expires 01/26/2024. There are currently 5 residents who reside at this home and there is 0 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Water temperature was tested at 122 degrees. Toxins and cleaning supplies are locked and inaccessible. LPA ensured all staff present is background cleared. LPA Hurt observed the hallway in the entrance outside of Resident 1's bedroom to have a urine, body odor smell. LPA observed the window screen located outside the living room area to be torn. LPA observed the facilities first aid kid to be incomplete, and missing a guide. LPA Hurt was not screened for COVID 19 symptoms upon entering the facility, and Staff 1 was not wearing a mask. Administrator Rodrigo Fontejon did not have a copy of COVID 19 vaccine card or exemption on file. The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Licensee Rodriga Fontejon and copy of report left at facility