Routine inspection·May 31, 2024

On May 31, 2024 at 1:15PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Supervisor (SV) Juana Gonzalez and explained the purpose of the visit. Administrator Shimon Cagan was contacted over the phone to explain he could not attend today's visit. The facility is licensed to operate for six (6) non-ambulatory and have a hospice waiver for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) resident bedrooms, two (2) bathrooms, living room, dining room, kitchen, an attached garage, and an outside covered patio area. LPA Kim toured indoor and outdoor of the physical plant with SV Gonzalez. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each client’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, and Resident Room 3. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 114.9 and 115.1 degrees F. A comfortable temperature of 73 degrees F was maintained in the facility. LPAs Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. The facility has two (2) fire extinguishers that are charged and they were all serviced on March 12, 2024, smoke detectors, and carbon monoxide detectors were operable. A working telephone (657-210-4114) remains available. First Aid Kit contained all the necessary elements. Evaluation Report Continues on LIC 809-C During the visit, LPA Kim observed the facility's infection control practices. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA Kim reviewed the facility’s plan of operation, infection control plan, and emergency and disaster plan.. LPA Kim conducted an audit of all resident files (R1-R5), staff files (S1-S3), and medication and medication administration record. LPA Kim conducted 2 staff interviews and no residents because all residents were out in the community. A deficiency was cited during this inspection visit according to the California Code of Regulations (Title 22, Division 6). An exit interview was conducted, and a copy of this report was provided to Supervisor Juana Gonazalez.