Routine inspection·October 5, 2023

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit on 10/4/2023. LPA was granted entry and met with staff, Dennise Gutierrez, who was informed of the purpose of the visit. At the time of the visit there was (1) staff and (1) clients present. The facility is a one story home with (6) bedrooms and (3) bathrooms with attached garage. No pools or firearms are being kept at the facility. The residents served are elderly ages 60 and over. The facility is approved for a capacity of (6) non-ambulatory residents of which (1) may be bedridden. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted a staff and resident interviews. LPA observed the following: Infection Control: The LPA observed hand washing stations in the facility stocked with supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. The facility has an infection control plan, however the licensee and staff were unable to show these documents in a timely manner. Physical Plant: Physical plant, floors, windows, and doors were observed to be clean. Facility is in need of repair, with broken ramp. The smoke detector and carbon monoxide was operational, and the hot water temperature 105.8F. LPA observed unlocked chemicals in the laundry room, this will be cited. LPA observed staff belongings in an unapproved room which is used as a passage way to a restroom. Facility will be cited for this. Care & Supervision / Administration: The licensee has a staff schedule, however the licensee was unable to provide this to the LPA in a timely manner. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The listed administrator, possesses a current administrator's certificate. Record Review and Resident/Staff Files: LPA reviewed (3) staff files and training. (1) staff does not have CPR on file. Staff training was not provided to the LPA during the time of the visit. (1) staff is currently residing in the home and does not have a staff file at the facility. Two (1) resident file was reviewed, and possessed all required paperwork. The facility will be cited for incomplete staff files. Health Related Services/ Incidental Medical Services: All client medication was kept locked in facility pantry. The LPA observed medication for Resident #E1 (R1) whom no longer resides at the facility. LPA observed undestroyed controlled medication for the resident is being stored at the facility. Facility will be cited for this. Due to time constraints, the annual will be continued on a later date. Observations were documented and will be addressed during the annual continuation. An exit interview was conducted where a copy of this report, 809-D pages and appeal rights were reviewed and provided to staff, Dennise Gutierrez.