Routine inspection·January 31, 2024

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose to conduct the Required 1-Year Annual Inspection. LPA was greeted and granted entry after stating the purpose of the visit to Caregiver Veronica Gastelum. Administrator (Admin) Lourdes Rivero was not present to assist with the facility inspection on today's date. LPA spoke to the Admin by telephone and consented Caregiver Martinez to sign the report on her behalf. LPA conducted a tour of the physical plant accompanied by Caregiver Martinez, and the following was observed: This is a single story facility comprised of four resident bedrooms and three resident bathrooms, laundry room, living/family room, dining room, and a two-car garage. LPA toured the outside grounds. There was shading and sufficient seating for the residents. The exit gates were self-closing and self-latching. LPA observed three residents and two caregivers on duty. The resident bedrooms are spacious and easily accommodates the residents' furnishings. Furniture for each resident bedrooms were inspected. The bathrooms were clean, faucets, toilets, and grab bars were operational. The hot water temperature initially measured at 133.7 in the private bathroom, 131.5, and 127.4 degrees Fahrenheit in the shared bathroom. The water heater was readjusted and corrected during the visit which then measured at 117.6, 116.2, and 118.9 degrees Fahrenheit. There were sufficient supply of clean linens. LPA observed a two-day supply of perishables and a seven-day supply of non-perishable food as required per egulation. Carbon monoxide, smoke detectors, and the auditory devices were tested and operational except in Bedroom #1. Caregiver Martinez was unable to reach and test the two smoke detectors located in the hallway by the entrance and in the master bedroom. The fire extinguishers were serviced on 04/07/23. Medications and sharps were locked and inaccessible to the residents. Toxins in the laundry room and under the sink were not secured at the time of inspection. Facility had ample supply of emergency supplies including food/water. LPA reviewed three out of the three resident files and two out of the two staff files including the resident medications. LPA is reminding the following: Licensee to pay the licensing fees due on 03/30/2024, to ensure at least one staff on duty with a CPR/First Aid training is on premise at all times, to submit a recording of the testing of the (2) smoke detectors, to repair/replace the smoke detector in Bedroom #1, to replace (1) magnetic lock to the left sink cabinet, to ensure the laundry room is locked at all times, to complete the missing sections of the LIC610E (Emergency and Disaster Plan), to notify the Department designating a facility representative during the administrator's absence, to accurately document when the medication was refused on the Medication Administration Record (MAR), and to dispense the medications matching the corresponding date. Based on the observations made during today's visit, a deficiency is being cited as per the Title 22 Division 6 Chapter 2 of the California Code of Regulations. Advisory Notes (LIC9102s) were also issued during the visit. An exit interview was conducted with Caregivers Ana Maria Martinez and Veronica Gastelum, and a copy of this report including the LIC809C, and the LIC9102ss were provided at the end of this visit.