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Inspection visit

Routine inspection

GOOD SAMARITAN GUEST HOME IVLicense 3060013083 citations on this visit
3 citations recorded

Inspector’s narrative

What the inspector wrote

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPA was greeted and granted entry by facility caregiving staff after explaining the purpose of the visit. Facility administrator Leonardo Cambio was notified by telephone and arrived shortly afterwards to assist. During the inspection, LPA and facility staff conducted a tour of the physical plant and observed the following: The facility is a one story home with 3 shared rooms and one staff room in addition to the facility's common living areas and two full bathrooms. All resident bedrooms have the required furnishings. LPA observed all beds have linens and blankets. The backyard has a shaded area and the routes of egress are free of clutter and obstructions. There are currently four residents admitted to the facility with no resident receiving hospice care. Residents are observed to be clean and appear well taken care of. Bathrooms faucets and toilets were operational. Water temperature was verified to be within acceptable range. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required. Combined smoke and carbon monoxide detectors tested operational. Fire extinguisher present are observed to be fully charged. Medication, sharp items were confirmed to be inaccessible throughout the physical plant, however bleach was observed under the kitchen sink and secured in the garage during the visit. The medication central storage was also observed to be secure and reviewed for accuracy during the visit. LPA reviewed four resident files and three staff files. Based on the observations made during today’s inspection, one type A deficiency and two type B deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations along with four advisory notes provided. An exit interview was conducted, and a copy of this report along with appeal rights was left at the facility.

Citations

3 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 1569.695(c)Type B

    Based on interview and records reviewed, the licensee did not comply with the section cited above as drills are conducted but not documented.This poses/posed a potential health, safety or personal rights risk to persons in care.

  • Request a transfer of criminal record clearance

    Based on staff records reviewed, the licensee did not comply with the section cited above as one relieving caregiver was noted to be associated to a different facility operated by the licensee but not to the present location. Thich poses/posed a potential health, safety or personal rights risk to persons in care. Civil penalty assessed.

  • Fire approval and staff access to unlock systems

    Based on observation conducted during the facility visit, the licensee did not comply with the section cited above as bleach was observed to be present in an unsecured kitchen cabinet. This poses an immediate health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the June 17, 2024 inspection of GOOD SAMARITAN GUEST HOME IV?

This was an inspection of GOOD SAMARITAN GUEST HOME IV on June 17, 2024. 3 citations were issued: 1 Type A (serious) and 2 Type B.

Were any citations issued to GOOD SAMARITAN GUEST HOME IV on June 17, 2024?

Yes, 3 citations were issued (1 Type A, 2 Type B). The first citation was for: "Based on interview and records reviewed, the licensee did not comply with the section cited above as drills are conducte..."

What type of inspection was this?

This was an inspection. Inspections are conducted by CCLD as part of their licensing oversight.

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.