Routine inspection·December 27, 2023

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Michelle Matamoros and was granted entry to the facility. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of six (6) non-ambulatory residents, two (2) residents may be bedridden. The current census is six (6) residents. LPA was accompanied by Administrator to conduct a general overall inspection, which included, but was not limited to, the following: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to interior and exterior passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperature in the bathrooms to be at 120 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCL complaint poster, labor laws, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident and staff files. Medications are kept inside the hallway cabinet inaccessible to residents. Non-perishable and perishable food supply is sufficient for the residents in care. Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. LPA reviewed six (6) residents files for admission agreements, updated physician reports, and needs and services plans. LPA found that Resident’s R1, R2, and R3 have a condition that requires an annual updated physician report. R1’s physician report is dated 4/28/2022. R2’s physician report is dated 8/29/2019. R3’s physician report is dated 10/29/2020. The facility will be issued a deficiency for not having updated physician reports for the residents. LPA reviewed six (6) staff files for First Aid/CPR certifications, criminal record clearances, trainings, and health screenings. LPA found that Staff S1 does not have a staff file at the facility. The facility will be issued a deficiency for not having a staff file for S1. Based on the observations made during today’s visit, two (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D, and LIC811 were discussed and provided to Administrator Michelle Matamoros, along with a copy of the appeal rights.