Routine inspection·March 30, 2023

On 3/30/2023 at 1:37 p.m. Licensing Program Analyst (LPA) B. Miranda arrived at the facility to conduct a required unannounced annual inspection. LPA was greeted by staff S1. Administrator (AD) was contacted, and AD’s wife S2 was informed S1 would be conducting the annual inspection since AD was not able to make it at this time. LPA observed two caregivers at the facility. S3 is not associated with the facility which will result in a citation Per California Code of Regulations , Title 22, Division 6, Chapter 8, 87355 Criminal Record Clearance. LPA toured the facility inside and out. Entry way was clear and free from obstructions. Temperature in the facility was comfortable. Facility currently has 6 residents. Facility has 5 bedrooms and 2 bathrooms. Two residents share a room and the other 4 have their own rooms. All rooms were observed to have proper lighting, furniture, and storage for residents. LPA observed kitchen to be clean and free from clutter. Knives were observed to be locked away and inaccessible to residents. LPA observed sufficient seven day non-perishable food items and two days’ worth of perishable food items at the facility. Medication was observed to be locked and inaccessible to residents. Two resident files and medication logs were reviewed. LPA observe medication log not being signed off as medication is taken, S1 stated the log is signed off at the end of shift. LPA observed bathrooms to be clean, free from clutter, and odor free. Bathrooms were observed to have pull bars and non-slip mats. Water temperature was check in the common bathroom and read at 112.2 degrees Fahrenheit. See LIC809C Facility has 1 fire extinguisher which is current, in good standing, and last serviced 6/6/2022. Smoke detectors were checked and observed to be in working condition. LPA observed fire clearance exits from inside the house to be clear and free from obstruction. LPA observed the fire exits from the back yard to be obstructed. One exit is obstructed with part of a pellet and the others with a screen door (pictures taken).Citation will be issued Per California Code of Regulations , Title 22, Division 6 Chapter 8 87202 Fire Clearance. Exit interview was conducted and copies of this report, LIC809C, LIC809D, and LIC421BG were provided to S1. At about 4:45 S4 arrived to the facility who is also not associated. S2 was contacted and stated S4 previously quit and returned working at the facility 3/5/23. The following documents were requested and are due 4/13/2023 by end of the day. Residential Care Facility for the Elderly (RCFE): LIC 308 Designation of Facility Responsibility -as applicable: LIC 309 Administrative Organization -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources -as applicable: LIC 402 Surety Bond LIC 500 Personnel Report Staff Schedule for March LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly LIC 9020 Register of Facility Clients/Residents Copy of current Liability Insurance Copy of current Administrator Certificate Alternate contact information including name, telephone number, & email address.