Post-licensing visit·April 10, 2025

On 04/10/2025, at approximately 1:00 PM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced at the facility to conduct a post-licensing inspection and met with Safir Rezzoug, Licensee. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care, all of whom were present during today's inspection. Facility has a Dementia Care Plan, a Hospice waiver for four (4), and is approved for four (4) non-ambulatory residents. At approximately 1:45 PM, LPA initiated a tour of the facility with Licensee and observed the following: Facility is a one story home, was a comfortable temperature, and passageways were free from obstructions. Water temperatures in residents' bathrooms measured at 132 degrees F which in outside the allowable range of 105 to 120 degrees F per Title 22 regulations. Licensee agreed to turn down the water heater and track the facility's water temperatures over the next 10-days to ensure the facility has been brought back into compliance with regulation. LPA observed a supply of clean linens, and hygiene, incontinent care, and paper products available for residents. Residents' bedrooms were inspected and observed to have all the appropriate furnishings as outlined in Title 22 regulations. Cabinets containing cleaning supplies and other items that could pose a risk were locked. LPA advised Licensee to increase the amount of fresh fruit and vegetable available to residents in the facility. Licensee agreed. LPA informed Licensee that no staff shall sleep in the garage area of the facility as it is not a cleared space for staff sleeping quarters. Licensee conveyed understanding of this and agreed to comply. LPA advised Licensee that the required personal right poster and a copy of the current administrator's active certificate shall be posted in a conspicuous area of the facility. Licensee agreed to bring the facility into compliance with regulation. At approximately 2:00 PM, LPA began file review. LPA reviewed five (5) staff files and one (1) resident file. LPA observed three (3) of five (5) staff files missing proof of initial 40 hours of training, four of four staff file missing proof of initial medication training, and one (1) staff file missing proof of first aid training. Continued on LIC809C... Continued from LIC809... LPA observed Resident 1 (R1) missing the required annual physician's repot and updated appraisal needs and services plan. LPA informed Licensee that all required forms shall be signed by staff, resident, or responsible party to remain in compliance with regulation. LPA will return at later date to complete this post-licensing inspection and may issue citations at that time. Licensee informed LPA that they would like to change the facility administrator to himself. Required Change of Administrator Documents: LIC 308 (Designation of Facility Responsibility) Active and Current Administrator Certificate First Aid Certificate LIC 500 (Personnel Report) LIC 501 (Personnel Record) LIC 503 (Health Screening Report - personnel) Proof of Negative TB test LIC 9182 (Criminal Record Exemption Transfer Request) LIC 508 (Criminal Record Statement) Copy of Driver's License or Passport that is not expired Statement signed by Licensee requesting Change of Administrator Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : Proof of Liability Insurance (Updated) LIC308 - Designation of Facility Responsibility Current Administrator Certificate No deficiencies cited during today's inspection. Exit interview conducted with Licensee, whose signature on form confirms receipt of documents.