Routine inspection·October 20, 2023

Licensing Program Analyst (LPA) Cheryl Goodrich arrived at 10:51am to conduct an unannounced annual visit. LPA met the Caregiver Remedios Bautista at the front door and was granted entry. The House Manager, Charmaine Williams arrived at 11:00am. The purpose of today’s visit is to inspect the facility to ensure that the facility is following California Code of Regulations, Title 22, Division 6. The facility is a single-story home located in a residential area in San Jacinto, CA. The facility is licensed to six (6) non-ambulatory with 5 residents in care. The facility has a Hospice Waiver for 4 residents. Infection Control: The facility has an approved infection control plan and a surplus of supplies for infection control including but not limited to mask, gloves, gowns, first aid kit, and cleaning supplies. Physical Plant and Environmental Safety : The facility temperature read at 73 degrees. The facility consists of 4 resident bedrooms, and 3 bathrooms, living room, kitchen, and backyard. The bedrooms are furnished with lighting, closet space, tv and dresser. The beds are clean and have clean linens and the pathways are clean and clear of obstruction. The bathroom temperature read at 106 degrees which is within regulation requirements. The living room and kitchen clean and clear of obstruction. (Continued on LIC809-C) (Continued from LIC809) The medications are stored in a locked cabinet in the hallway and inaccessible to the resident. The facility has a current fire clearance, smoke and carbon monoxide detectors and fire extinguishers and are in working order. Personnel Records-Training: The staff records are completed with fingerprint clearance, Health screening for TB, CPR/First Aid training, and in-service trainings. Client Records-Incident Reports: The facility has identification and emergency information, physician’s report, resident appraisal, client rights, and admissions agreements. Client Rights-Information: The facility has client rights information posted in the facility. Food Service: 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available. Health- Related Services: The facility has a medication logbook; the facility documents the resident’s medication and in is compliance with physician’s orders and regulations. Disaster Preparedness: The facility has a disaster plan and has posted the evacuation plan, visible for staff and residents in care. The next fire drill is scheduled for 10/25/23. The facility has emergency supply of food and water. Summary: No deficiencies were observed at the time of the visit. An exit interview was conducted and a copy of this report was provided to House Manager Charmaine Williams and her signature on this form confirms receipt of these rights.