Routine inspection·July 12, 2024

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Francisco Bautista. According to the facility’s license, the facility has a maximum capacity of six residents, of whom all may be non-ambulatory and one may be bedridden. LPA toured the interior and exterior of the facility and inspected each room. This facility is a two story home, second floor is staff only. The facility was sanitary. LPA observed multiple uncovered electrical outlets in the living room space and unfinished walls. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were cleaning supplies accessible to residents under the kitchen sink and bathroom sinks. Knives were easily accessible in kitchen drawer. Medications were labeled, as required, but not stored in locked area, making them accessible to residents. No pool or body of water present. Water temperature was measured at 118 degrees F. Per Francisco, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit was complete. No fire drills have been conducted this quarter. No oxygen in-use sign was not present while there is a resident on oxygen. Resident 1's (R1) LIC 602 physician report had not been updated since 2018 and has a diagnosis of a major neurocognitive disorder. Resident 2 (R2) did not have an order for a full bed rail and was not on hospice. Staff records reviewed contained required documentation. Multiple deficiencies were issues on today's date and one technical violation. An exit interview was conducted with Caregiver, to whom a copy of this report, LIC809 D (x3), LIC9102 and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.