Routine inspection·June 2, 2023

Licensing Program Analyst (LPA) Victoria Bertozzi arrived unannounced to conduct an Annual Required inspection and was greeted by staff. Administrator, Maria Socorro Hernandez arrived later. LPA initiated a tour of the facility around 11:40am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Residents rooms were furnished per regulation. One of six residents had a full bed rail on their bed, which is not allowable per regulation. Administrator indicated that the full bed rail is not used so LPA requested that it be removed. It was removed during this inspection. Water temperature in bathrooms used by residents measured at 120 and 129 degrees F which are not all within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Multiple cabinets in the bathroom were locked and after Administrator explained what items were in the cabinets LPA clarified that those items are not required to be locked, per regulation. Cabinets containing cleaning supplies were locked. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality but not all were stored per regulation. Pantry items were locked. LPA explained that if facility wanted to lock food, they would need to request a waiver from the Department. Facility opted to remove locks during inspection.. Medications were centrally stored and locked. Fire extinguisher was last serviced April 2023. Facility has hardwired smoke detectors located throughout the facility as well as a Carbon Monoxide detectors that were tested and operational during inspection. Most recent fire/disaster drill was conducted 3/2023. Continued on LIC809C Continued from LIC809 Four staff files and six resident files were reviewed. Staff have required First Aid and CPR certificates. Administrator Certificate for Administrator, Maria Socorro Hernandez 6014614740 expires 4/28/2024. Medications and medication records were reviewed. Licensee/Administrator to submit updates of the following documents by 7/02/2023: LIC 500 Personnel Summary LIC 308 Designation of Responsibility Copy of Liability Insurance LIC 610 Emergency Disaster Plan (If changes) Infection Control Plan (If changes) Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.