Routine inspection·October 24, 2023

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Staff #1 (S1) Lorna Awang and discussed the purpose of the inspection. Administrator (AD) Maxine Kniazeff arrived during the inspection. LPA reviewed Infection Control requirements. At about 9:15AM, LPA toured the facility with S1. S1 left the facility and LPA continued the inspection with AD. LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: this is a one-story home. Facility is a 5-bedroom, 2-bathroom, one-story house with detached garage that is being used for storage. LPA observed 1 staff and 0 residents present at the facility. Resident Bedrooms: the 5 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: there are no staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 115 degrees F in the common client bathroom and 117 in the private client bathroom. LPA inspected all rooms in the facility. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested, including the wired smoke detectors/carbon monoxide detectors. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the kitchen. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. LPA discussed licensing fees with AD. At about 10:15AM, LPA reviewed 4 resident files and 4 staff files, interviewed 1 staff, inspected medications for 4 residents, and inspected resident money and ledgers for 4 residents. CONTINUED. During the inspection, LPA and AD observed the following. Per Physician’s Report dated 02/09/23, Resident #1 (R1) is non-ambulatory but the facility does not have a fire clearance for non-ambulatory residents. Per staff files, S1, S2, S3, and S4 did not complete the 40-hour initial or 20-hour annual training. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421IM. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.