Routine inspection·September 17, 2024

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by House Manager (HM), Victor McKenzie and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for three. Currently there are four residents, of which one is on hospice during today's visit. LPA Tea along with the house manager toured the facility at 2:31 PM. LPA toured the physical plant, checked food service, and the first aid kit. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms and are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 77.0 F degrees and over 130 F degrees. HM McKenzie was adjusting the boiler, lowering the temperature. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. First aid kit had all the required elements including bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be locked and inaccessible to clients in care locked and secured in cabinets by the laundry area. The fire extinguisher in the kitchen is fully charged. The kitchen stove had one working burner at the time of visit. LPA toured the outside grounds and there is ample seating with shade and two exit gates on both sides of the facility is self-latching and operational. LPA observed emergency supplies, food and water supply in a cabinet in the family room. Facility provides activities based on resident interests. At the time of annual visit, residents were seen having snacks and watching television in the family room. LPA Tea reviewed four resident files and two staff files. There were discrepancies noted in the review of resident and staff files. Administrator (AD) Eduardus Junanto certificate expires on June 05, 2025. Annual report continued on LIC809C LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. LPAs interviewed residents regarding their quality of care and spoke to staff present regarding care provided. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with House Manager, Victor McKenzie and a copy of these reports were given to the facility along with a copy of the LIC 858; 859;809-D, and Appeal Rights.