Routine inspection·March 16, 2023

Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to conduct a Required – 1 Year Annual inspection. Upon arrival LPA was greeted and granted entry by Carestaff Hermelinda Palma and May Ong. LPA began inspection with introduction and visit purpose. There are currently 6 Residents residing and present at the facility. Facility currently has 1 resident receiving Hospice care. Administrator (AD) Chi "Rex" Luu arrived shortly after. LPA along with AD Rex conducted a tour of the inside and outside of the facility. LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature for the Residents. Lighting is sufficient for safety and comfort. The facility is a two story, 5 bedroom, 3 bathroom home with a dining room, living room, kitchen, and attached garage on first floor. The second floor has 2 bedrooms, and 1 bath that is used by staff only. There is a back yard with a patio cover for the residents. Resident bedrooms were observed to be spacious and easily accommodate furnishings such as lamps, chair, dresser and a bed. Bathrooms were clean, faucets, showers and toilets were operational. Water temperature tested at 115.7 degrees F. Linen and hygiene supplies were stocked in 2 hallway closets. Emergency Phone Numbers and Exit Plan were reviewed. Food prep areas are clean and organized. Food supply does not meet the requirement of one (1) week supply of non-perishable and two (2) day supply of perishables. Emergency food and water supply is available. Smoke detectors are centrally wired and carbon monoxide detectors were found to be operational. LPA and AD observed the 3 Fire Extinguishers that were mounted were last serviced on 04/15/2021. Stove burners, microwave, washer, and dryer are operational. There is a locked location for chemicals and sharps in the kitchen. Laundry is done in the garage, and there is a locked cabinet for storing laundry soap and other chemicals. Medications are centrally stored in a locked metal file cabinet. Medications reviewed appear to have been dispensed accurately. (see LIC809C) First-Aid Kit and Activity Supplies, were observed and available. There is a working land line at the facility. The LIC610, Emergency Disaster Plan is posted. Facility’s licensing fees are fully paid. Indoor passageways are free of obstruction. LPA noted an old box spring and an old commode on the side of home by the exit gate. LPA also observed the exit gate is not self latching and scrapes at the bottom. Resident Files/Incident Reports/Personal Rights/Incidental Medical and Dental - LPA reviewed 3 Resident files. LPA noted Admission Agreement, Medical Assessment and TB test results, Identification and Emergency information, Appraisal Needs and Service Plan, Consent forms, Centrally Stored Medication/Destruction Records, Safeguard for Personal Property/Valuables, and Personal Rights Notification. Personnel Records/Training/and Staffing- Two (2) records were reviewed. LPA reviewed employee records for First Aid certification, Finger Print Clearance, Personnel/Job Application, Health Screening and TB test results, Criminal Record Statement, Employee Rights, and Training Verification. Administrator is unable to provide proof of initial and/or Annual training for Staff 1 and Staff 2. Administrator Certification, expires on 07/25/2023. LPA interviewed 2 of the 6 residents and 1 staff. LPA reviewed medication for 2 Residents. Based on the information received during this visit today in the areas reviewed, deficiencies are being cited per Title 22, Division 6 of The California Code of Regulations. Copy of this report will be sent to email on file.