Routine inspection·April 2, 2024

Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility for the purpose of conducting a 1 year required visit/annual inspection. LPA was greeted and granted entry by Caregiver Evangeline Dela Rosa, where LPA explained the purpose of the visit. At the time of the visit there was three staff and six residents present. Staff #1 (S1) was observed to not have obtained proper fingerprint clearance, nor to be associated to the facility, and was escorted off the premises, an immediate $500 civil penalty is being assessed. The Administrator Jamie Teng, was unavailable to come to the facility as they were out conducting resident interviews but was available via telephone. LPA conducted a tour of the interior and exterior of the facility. The facility was observed to be clean and clutter free. LPA observed for there to be several games, available for the residents to play and interact with one another. The medications were observed to be locked and inaccessible to residents in care. LPA did not observe an adequate supply of hygiene items, or personal protective equipment (PPE). There is a covered patio, with plenty of seating available. LPA observed for there to be two (2) added on staff bedrooms inside the garage. Staff on grounds denied being live in caregivers, and that the rooms are used to take breaks. The facility needs to be updated and submitted to the regional office. Food service: the facility was observed to have a 2 day supply of perishable and a 7 day supply of non perishable food items. LPA observed for the facility to have expired food items such as oatmeal, cream of wheat, box mashed potatoes, canned goods, corn bread mix dating back to May 2021. The expired food items were discarded at the time of LPAs visit, therefore a citation was not issued. The hot water was tested in all three resident bathrooms and was found to be within regulatory limits, measuring 106.5-115.3 degrees Fahrenheit. It is unknown as to when the last emergency disaster drill was conducted as the logs were unavailable for LPA to review. The facility does not have an active mitigation plan on file that was submitted to the regional office, in addition the smoke detectors were not operable, as they could not be tested, LPA observed for the cover to be open with no battery inside. The facility does not have a carbon monoxide detector, an immediate $500 civil penalty is being assessed. LPA was unable to review both staff and resident files as per Jamie Teng, Administrator, the facility has gone all electronic and he had the documents with him. Jamie stated that he would send the docs, however they were not received during LPAs inspection. The facility was observed to have the required postings, the emergency disaster plan was observed to not have been updated since 05/01/2018. The following is to to be submitted to the regional office: -LIC808 Mitigation plan, LPA emailed PIN 20-48-ASC to the Administrator for review -Updated facility sketch -Emergency disaster plan (LIC610E) -(3) Staff files requested -(3) Resident files requested -Image/video of additional hygiene supplies and personal protective equipment (PPE) As a result of today's inspection a meeting will be held at the regional office, in order to discuss the facility getting into compliance. Based on today's inspection deficiencies are being issued/cited in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8) on the attached 809D. An exit interview was conducted and a copy of this report, appeal rights, 809D, LIC421BG, LIC421IM and LIC 9098 Proof of Corrections for was reviewed and provided to Evangeline Dela Rosa.