Routine inspection·December 13, 2023

On 12/13/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene was greeted and granted entry by Caregiver, Dawn Jensen who was informed of the purpose of the visit. LPA spoke to Administrator, Thomas Uata via telephone who was also informed of the purpose of the visit. At the time of visit there was three #3 staff and five #5 residents present. LPA toured the facility inside and out with Dawn Jensen. Tour included: Kitchen: LPA toured the kitchen and observed kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the census. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen drawer, available only to authorized individuals. Trash cans has tight-fitting lids. Fridge, freezer, and all need appliances were present and shown to be in working condition and clean. Dining and Livingroom; LPA toured the dinning and Livingroom area. LPA observed area to be clean and furnitures in good condition. Temperature was 73 degrees Fahrenheit. Hallway: LPA toured the hallway and observed hallway to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector were tested and functioning properly. LPA observed additional linens and hygiene items. Medication: Medications were labeled and stored in separate bins inside of a locked medication closet and are distributed according to physician orders. The first aid kit was complete. Continue on LIC809-C Continued from LIC809. Bathroom: LPA toured hallway bathroom and observed bathroom to be clean and equipped with grab bar and non-skid mat. There is also a good number of personal toiletries available for the residents in care. The hot water measured at 114 degrees Fahrenheit. Bedroom: LPA toured four #4 out of #4 resident bedrooms and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs, and lighting. Resident #1 bedroom has a private bathroom. LPA observed bathroom to be clean and hot water was measured at 114 degrees Fahrenheit. Garage: LPA tour the garage and observed garage to be clean. Laundry: Washing Machine and Dryer are all in good repair and sufficient for the census. Cleaning supplies are stored away in the laundry room, inaccessible to clients. Backyard: LPA toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction and the side gate remain unlocked. No bodies of water were observed. Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents. Fridge and freezer are large enough to accommodate required perishable foods. Records: All staff present were confirmed as being associated with the facility. LPA requested for three #3 staff and #3 residents' records. Three residents and two staff records were reviewed. One staff had no documentation of criminal record clearance, TB test, and Health screening. Administrator informed LPA that documents were completed but are not present at the facility. Administrator also informed LPA that the third staff has a file, but the file is not present at the facility ( citation will be issued) . All required postings were posted near the entryway and throughout the facility. The administrator certificate expires on 2/5/2025. Interview: Three #3 staff and four #4 residents were interviewed. Therefore, based on the observations made during today’s visit, one #1 deficiency will be cited per Title 22, Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted, and this reported was provided along with appeal rights to Dawn Jensen.