Routine inspection (multi-day)·March 22, 2024

On 3/22/2024, Licensing Program Analysts (LPA) Jenifer Tirre, Edward Kim and Licensing Program Manager (LPM) Lourdes Montoya conducted an unannounced required continued Annual visit using the CARE Inspection Tool. LPA’s & LPM were greeted by Staff and granted entry after stating the purpose of the visit. Administrator (Admin) Mary Jean Catacutan was not present to assist with the facility inspection on today's date. Licensee Weenie Earwood came to facility to assist with inspection visit. The facility is licensed for six (6) non-ambulatory residents with approved hospice waiver for three (3) residents and (1) bedridden. Currently, there are three (2) Hospice residents present during today’s visit. This is a single story with a two-car garage facility. The facility has five resident bedrooms, one staff bedroom, and three full bathrooms. At around 9:15AM, LPA’s & LPM conducted a tour of the physical plant accompanied by Licensee Earwood, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 106.1 degrees F. A comfortable temperature of 69 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility has one fire extinguisher which is fully charged and mounted. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. CONTINUED ON 809C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has supply of Personal Protective Equipment (PPE). LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on January 10, 2024. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 11/8/2023 - 11/8/2024. The facility is current on Community Care Licensing annual dues. A review of three residents (R1-R3) service files and one out of three staff (S1) personnel files revealed to be incomplete. The facility has the current administrator's certification on file for Mary Jean Catacutan # 6036186740 - Expiration 8/2/2025. Based on the observations made during today's visit, deficiencies are being cited as per the Title 22 Division 6 Chapter 2 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Weenie Earwood.