Routine inspection·July 17, 2024

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with caregiver Jocylyn Late and was granted entry to the facility. Licensed capacity is (14) current census (11). LPA was accompanied by caregiver Jocylyn Late and Administrator Francisco Balisl to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated office for client/staff files. During facility tour, LPA observed outdoor activity area not easily accessible for residents in care. Outdoor patio was surrounded by large boxes, bed mattresses and pervious residents’ wheelchairs. Administrator had agreed to relocate items to their storage space. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (3) resident files for admission agreements, updated physician reports, and needs and services plans. 1 out the 3 residents did not have their annual medical assessment, which is required for dementia residents. R1 last medical assessment was conduct in 2021. LPA reviewed (3) resident medications. 1 out of the 3 residents prn medication, did not have the exact date and time it was provided. LPA also reviewed (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Based on the observations made during today’s visit, two (2) Type A and one (1) Type B deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Administrator Francisco Balisl. Along with a copy of appeal rights.