Routine inspection·July 1, 2024

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Lornita S. Panis and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 8:30AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 4-bedroom, 2-bathroom, one-story house with detached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 2 staff and 3 residents present at the facility. Resident Bedrooms: the 3 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the 1 staff bedroom. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 115 degrees F in both bathrooms. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA 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 laundry room, after corrections. Toxins: observed locked in the garage and laundry room, 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 9:15AM, LPA reviewed 3 resident files and 2 staff files, interviewed 3 residents and 2 staff, and inspected medications for 3 residents. Facility does not handle resident money. CONTINUED During the inspection, LPA and AD observed the following: based on observation, the licensee did not ensure toxins were secured in the non-lockable garage, knives were secured in the non-lockable cabinet under the kitchen sink, and Tylenol was secured in the kitchen cabinet; based on documents, the licensee did not ensure the medications of 3 out of 3 residents were tracked by not using a Medication Administration Record (MAR). 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. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.