Routine inspection·February 25, 2025

On 02/25/2025 at 02:15 PM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct the required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. At the time of the visit there were one (1) staff present, and four (4) residents present. Licensee/Administrator Mercillina Ajunwa was contacted and informed of the visit. Licensee/Administrator Ajunwa arrived during the visit. LPA Brown explained the purpose of the visit to Licensee/Administrator Ajunwa. The facility has 6 bedrooms, in which five (5) bedrooms are designated for residents, and one (1) bedroom's designated for staff, 3 and 1/2 bathrooms, living room, kitchen, dining area, backyard, laundry room and attached garage. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of six (6) non-ambulatory residents, one (1) resident may be bedridden. The current census is four (4) residents. The facility has approved hospice waiver for four (4) residents. LPA Brown was accompanied by Staff #2 (S2) to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). The buildings and grounds were free from hazards. Outdoor and indoor passageways were kept free of obstruction. The facility is maintained at a comfortable temperature of 68 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperature in the residents/staffs shared bathroom to be at 105.2 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCLD complaint poster, ombudsman 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/staff files. Medications are kept inside the medication closet ***Continuation in LIC809C*** near the kitchen inaccessible to residents. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service : Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. LPA observed the facility have emergency supplies, food and water. Care & Supervision : Facility has sufficient care staff for coverage 24 hours a day, 7 days a week and a night staff, awake and on duty at night for facility with dementia residents. Record Review : The facility has updated Liability Insurance and Infection Control Plan maintained at the facility. LPA reviewed four (4) resident files for admission agreements, updated physician reports, pre-placement appraisals, centrally stored medications list, needs and services plans. LPA Brown observed that Resident #2 (R2) Admission Agreement does not have the Licensee/Facility Representative Signature and no signature date. Deficiency will be issued. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. LPA observed Staff #2 (S2) working at the facility with criminal background clearance but S2's criminal background clearance was not transferred to the facility prior to employment on 11/2024. Deficiency will be issued and civil penalty of $500.00 will be assessed today, and will continue to be assessed of $100.00/day until corrected. Medications/MARs records were audited for two (2) residents and appeared to be dispensed and logged appropriately. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D, LIC421BG and Appeal Rights were discussed and provided to Licensee/Administrator Mercillina Ajunwa.