Routine inspection·May 22, 2024

This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Sean Haddad and Michael Tea for the purpose of conducting a Required – 1 Year Inspection. LPAs met with Administrator (AD) Josefina Gutierrez and discussed the purpose of the inspection. LPAs reviewed Infection Control requirements. At about 8:45AM, LPAs and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and storage areas and observed the following: Structure: facility is a 6-bedroom, 4-bathroom, one-story house with no garage. There is a back yard with a patio cover for the residents. LPAs and AD observed 2 staff and 4 residents present at the facility. Resident Bedrooms: the 5 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPAs inspected the 1 staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 113 and 118 degrees F in the 3 resident bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the hallway closet, after corrections. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 9:45AM, LPAs reviewed 4 resident files and 2 staff files, interviewed 1 resident and 1 staff as all other residents were sleeping and staff were unavailable, and inspected medications for 4 residents. Facility does not handle resident money. CONTINUED During the inspection, LPAs and AD observed the following: based on documents, the facility does not have an Infection Control Plan; based on observation and documents, the fire extinguisher has not been inspected or replaced since 2022; based on documents, R1 is bedridden per their physician's report dated 10/25/23 but the facility does not have a bedridden fire clearance; based on observation, the licensee does not have nightlights anywhere in the facility; based on observation, the licensee did not ensure toxins were secured in the laundry room when staff could not locate the key to the lockable storage closet during the inspection, but the residents are all non-ambulatory and the facility has 2 staff caring for 4 residents to ensure safety; based on observation, the licensee did not ensure medications were secured in the non-lockable staff bedroom, but the residents are all non-ambulatory and the facility has 2 staff caring for 4 residents to ensure safety; based on documents, the licensee did not ensure S1 and S2 received their 20 hour annual training; based on observation, the licensee's PUB475 is letter sized; based on documents and admission, the facility does not have a current LIC610E and cannot locate their full emergency disaster plan; and based on documents and admission, the facility has not conducted an emergency disaster drill since January 1, 2020. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421IM. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.