Routine inspection·October 13, 2023

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with, Administrator, Lina Fojas. There are currently 4 residents in care. This facility is licensed for 5 non ambulatory residents, with hospice waiver approved for 4 of the residents and none of the residents are approved for bedridden. LPA toured the home and found the home organized at a comfortable temperature with all exits free from obstruction. This home is a two level home and all the resident bedrooms are located on the first level of the home. Residents have a call button to alert staff for assistance. Exit doors have auditory alarms to alert staff. Smoke detectors and carbon monoxide detectors were tested and operational. The fire extinguisher located in the kitchen was observed charged and facility had a proof of purchase receipt attached of 6/19/2023. Fire drills are conducted and the last one was documented on 8/6/2023. Water temperature in the resident bathroom was tested and found to be within appropriate range of 105-120 degrees. Bathrooms have required non-skid surfaces and grab bars. Cleaning products and knives are stored in locked cabinets in the kitchen. There was a 7 day supply of non-perishable foods. There are adequate dishes, glasses and silverware. Residents' medications are stored in kitchen locked cabinet. Resident and staff files are located and locked in cabinet. LPA reviewed staff files and staff did not have proof of the required 8 hours of Dementia training. Staff had proof of 1st aid but did not have proof of at least 1 staff having CPR at all times. LPA also found staff S1 who was previously associated to this facility, was no longer associated, as the administrator sent in a request to Community Care Licensing (CCL) to remove S1 and S1 was removed by CCL on 8/7/2023. Administrator rehired S1 but failed to request a fingerprint association to associate S1 to this facility prior to working. Resident files were reviewed and found in compliance. Continue report see LIC809-C LPA discussed Emergency Disaster Plan and Infection Control Plan. During todays visit, LPA requested facility to add lamps to all resident bedrooms. Licensee/Administrator to submit the current following documents by 11/10/2023: · LIC 308 Designation of Facility Responsibility (Received 10/13/2023) · LIC 500 Personnel Report- (Received 10/13/2023) · LIC 400 Affidavit Regarding Client/Resident Cash Resources (Received 10/13/2023) · LIC 610E Emergency Disaster Plan (Received 10/13/2023) · LIC 9020 Register of Facility Residents (Received 10/13/2023) Infection Control Plan of Operation (If changes) Copy of Liability Insurance- (Received 10/13/2023) Copy of Administrator Certificate See report LIC809-D for Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights provided. Exit interview conducted with Lina Fojas.