Routine inspection·December 24, 2024

Licensing Program Analyst (LPA) Brandon Lopez and Licensing Program Manager (LPM) Sheila Santos made an unnannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by caregivers staff after explaining the purpose for the visit. House Manager (HM) Madison Shelley was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Alan Shelley has a valid Administrator certificate which expires on March 24, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents with a hospice waiver for four. The facility is a single-story home with six private resident bedrooms, one staff room, two shared bathrooms, a living room, a dining room, a kitchen, and an unattached two car garage. LPA accompanied by the HM conducted a tour of the physical plant. On today's visit, LPA observed six residents in care and two caregiver staff present. LPA observed residents eating their breakfast in the dining room as well as eating in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall by the kitchen. LPA inspected the six resident bedrooms and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed that four residents had full bed rails. LPA observed additional linens are stored in a hallway closet. LPA inspected the two shared bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non skid floor mats. Hot water temperature measured between 114.2 and 114.8 degrees Fahrenheit. LPA inspected the staff bedroom and observed it to be unlocked and accessible to residents. LPA observed three chemical products that were observed to be stored in the staff bedroom. HM immediately removed the chemicals and locked it. LPA observed the kitchen has a two day perishable and seven day non perishable food supply on hand. LPA observed kitchen knives are stored in a locked kitchen cabinet. LPA observed cleaning supplies are stored in a locked kitchen cabinet under the sink. A fire extinguisher is located in a hallway by the kitchen and it was observed the be charged and serviced up to date 2/18/24. CONTINUED ON LIC809-C LPA tested the wired smoke detector/carbon monoxide detector which tested operational. LPA observed the facility conducted their last emergency disaster drill on October 1, 2024.The centrally stored medication is kept in a locked cabinet by the kitchen. LPA observed the First Aid kit has all the required components. The unattached garage is kept locked and inaccessible to resident. The garage is used for storage. LPA observed the facility has an emergency food and water supply stored in the garage. LPA and HM conducted a tour of the exterior portion of the facility. LPA observed the laundry room was unlocked and accessible to residents. LPA observed toxins stored in the laundry room. HM immediately removed chemicals and locked them. LPA observed a chemical was left unattended on the southside of the property. HM immediately removed the chemical and locked it. LPA observed two ladders were left unattended. HM immediately removed them and locked them in the garage. LPA observed a shaded seating area with furniture for resident use. Their are no bodies of water on the premises. LPA reviewed the six resident files. LPA observed that one of six resident's did not have a physician's report on file. LPA observed that two of four resident's did not have physician orders for full bed rails. HM immediately removed the bed rails. LPA reviewed six residents medication and medication records. LPA reviewed six staff files. LPA observed that Staff #2 (S2) was not associated to the facility. Civil penalties assessed. Based on today's observations, the facility is being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with House Manager Madison Shelley. A copy of the report was explained and Appeal Rights were provided.