Routine inspection (multi-day)·December 8, 2023

Licensing Program Analyst (LPA) Javier Prieto made an unannounced visit to the facility. The purpose of the visit was to conduct a required continued comprehensive annual inspection LPA met with Christian See, Designated Facility Representative and was granted entry to the facility. At the time of the visit there was two (2) staff present, and six (6) residents were present. The facility is a five (5) bedroom, three (3), bathroom home, with a kitchen/dining area, living room. Licensed capacity is (6) current census of six (6). LPA was accompanied by Mr See 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 (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected client 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 observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathrooms which measured 116.5 degrees F and 124.5 degrees F, respectively. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Smoke detectors were tested and three (3) were found not to be in working order, as well as one non-functioning carbon monoxide detector. Water temperature in the kitchen area measured 133.7 degrees at today's inspection. *****Continued on LIC 809C ******* Posters such as personal rights, ombusman poster, and the disaster plan were posted in a common area. The CCL complaint poster was not posted at time of inspection. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated storage space for client/staff files. Medications are kept inside lock box inaccessible to clients. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care. Client and Staff File Review: Six (6) resident files were reviewed during today's inspection. No Physician's report was observed for resident #2 (R2) and no Appraisal was observed for R4 and R6. Staff #1 (S1) file did not have a tuberculosis clearance and S2 file did not show the date of tuberculosis clearance nor the form of form of test, whether it be skin test or x-ray. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Care & Supervision: Facility does not have sufficient wake staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department 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 (LIC 809 and LIC 809C and LIC 809D) was discussed, signed by both LPA Prieto and Mr See and a copy was left with the facility, along with the appeal rights.