Routine inspection·May 29, 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) Gemma Sagucio and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 3:00PM, 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 6-bedroom, 3-bathroom, two-story house with attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA observed 2 staff and 4 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 3 staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 117 degrees F in the common resident bathroom. 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 kitchen, after corrections. Toxins: observed locked in the garage and kitchen, 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 3:30PM, LPA reviewed 4 resident files and 2 staff files, interviewed 4 residents and 2 staff, and inspected medications for 4 residents. Facility does not handle resident money. During the inspection, LPA and AD observed the following: based on observation and documents, the licensee did not ensure the two fire extinguishers were certified yearly when they were last serviced on 03/14/23; based on observation, the licensee did not ensure supplements and medications were secured in the non-lockable staff bedroom and sharps and toxins were secured in the kitchen where the key to the padlocks could not be located during the inspection; based on documents, no one present or associated with the facility has a valid administrator's certificate; based on observation, the facility has two stories but does not have an evacuation chair; and based on observation, the licensee has been using a full bedrail on the bed of R1 who is not on hospice and could not locate doctors' orders for half bedrails for all 4 residents who are using half bedrails. 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.