Routine inspection·November 4, 2022

Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted, granted entry into the facility by Administrator Yaninee Asawadilo and explained the reason for the visit. During the visit LPA toured the facility with Administrator. Facility is a 5 bedroom,( 4 resident bedrooms 1 staff bedroom) and 3 bathroom two story home. There are 4 Residents in care. LPA observed proper covid signage upon entrance of facility. Facility has required Department postings. LPA toured all Residents rooms, rooms had required furnishings such as bed, night stand, dresser and chair. All restrooms observed had working wash basin, contained soap, toilet paper, and hand towels. Residents were observed relaxing in the Living room eating lunch and relaxing in bedrooms watching TV. Facility has operating audible alarms for each sliding door entrance/exit. Facility has 2 fire extinguishers which are fully charged. Facility has supply of PPE and was advised to get additional PPE. Facility has two refrigerators with ample food supply. LPA observed facility has emergency food and water supply. Facility has required Emergency Disaster Plan posted. LPA observed Administrators certificate expiring 10/23/2023. Facility has a secured location for resident medication and files. Facility has 30 days supply of medications for clients. LPA reviewed Resident files during visit. LPA viewed 4 of 4 clients files. Resident emergency contact information is current. Facility has a designated visitation area. During Infection Control visit, LPA made the following observations: LPA observed medication bottles left out in unsecured locations in house. LPA also observed sharp scissors inside unlocked hall cabinet. During tour LPA observed a Lysol cleaning toxin spray unsecured in facility restroom. R1 has a diagnosis of Dementia. Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations Title 22. An exit interview was conducted and a copy of this report along with appeal rights and LIC 811 were left at the facility.