Routine inspection·August 7, 2024

Licensing Program Analyst (LPA) J Macias arrived unannounced to conduct a required Annual inspection and was greeted by Staff/Caregiver. LPA contacted Administrator Norbert Sacro was not available to come during Annual Inspection and gave permission for caregiver to sign reports. Facility contact information was reviewed.Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently six(6) residents in care. Facility approved/cleared for 3 ambulatory, 2 non-ambulatory, and 1 bedridden. One non-ambulatory, R2 resident is located on the second level of the facility, however fire clearance prohibits non-ambulatory residents on the second floor ( deficiency cited, see 809D and *Civil Penalty Assessed*) At approximately 9:30am, LPA and caregiver toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was not found to be stored in a safe manner with open items not labeled with opened date. Kitchen pantry containing bottled food contained multiple expired items ( Kikkoman sweet cooking seasoning exp 12/4/2023, Organic coconut aminos sauce exp 7/6/2021, Worcestershire sauce exp 2/20/2021, Bulls Eye bbq sauce exp 10/11/2020, Sugarman Maple syrup exp 1/17/2020, Sweet chili sauce exp 4/9/2021, chili beans exp 4/21/23, Kraft Parmesan cheese exp 4/23/23 and 9/12/21 (deficiency cited, see 809D ). LPA observed kitchen pantry cabinet where food was stored to have multiple rodent droppings on every shelf, underneath the kitchen sink and where the potatoes were stored (deficiency cited, see 809D ). Kitchen drawer with sharp knives locked . All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care measured at 101.8, 103.6 degrees F, which is not within the allowable range of 105 to 120 degrees F. (deficiency cited, see 809D). Fire extinguishers were last inspected May 1, 2023. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Facility’s last quarterly disaster drills was conducted June 7 2024. Continued on 809C... Continued from 809... At approximately 10:30am LPA conducted a review of 5 resident records. 4 out of the 6 residents, R2, R4, R5, R6 do not have current Appraisal Needs and Services Plan (LIC625) (deficiency cited, see 809D). R1 does not have a current LIC602 and an Appraisal Needs and Services Plan on file. ( deficiency cited, see 809D). At approximately 12:30pm LPA conducted review of (3) three staff records. LPA observed three out of three staff did not have required annual training on file (deficiency cited, see 809D ) . At approximately 2:00pm LPA and Caregiver conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet. Facility does not have a current Centrally Stored Medication List on file for residents in care. (deficiency cited, see 809D) Norbert Sacro Administrator Certificate 7006370740 expires 10/31/2024. LPA and Administrator discussed facility's Infection Control Plan and Emergency Disaster plan. No new updates. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Liability Insurance Current Lease Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given .