Routine inspection·April 7, 2025

Licensing Program Analyst (LPA) LaVette Farlow conducted an unannounced visit to complete the annual inspection. LPA met with Administrator Brett Powell for a Residential Care Facility for the Elderly (RCFE) for five (5) non-ambulatory residents, one (1) resident may be bedridden. LPA Farlow introduced self and explained the purpose of the visit. The administrator Brett, provided LPA with a space to work and conducted a tour of the facility. The facility has four (4) bedrooms and two (2) bathrooms. There are four (4) resident bedrooms, two (2) resident bathrooms, a kitchen, a living room, a dining area, a laundry room, a backyard, and an attached garage. LPA toured the interior and exterior areas of the facility. The following were inspected: Resident Bedrooms : All bedrooms have the required bedding and furniture, such as clean mattresses/linens, mattress covers, night stands, dressers, chairs, and lighting. Resident Bathrooms : The bathrooms appliances were operating in safe and sanitary condition. The water temperature was measured by LPA, the thermometer read at 131.0, 117.2, and 133.4 degrees F. Licensee adjusted the water heater immediately. A deficiency was cited. Kitchen and Dining Areas : Utensils and dishware are in good repair and readily available for residents in care. Kitchen appliances and counter tops were free of debris and in good repair. The chemicals were locked underneath the kitchen sink. The sharps were locked in the kitchen cabinet. Medication: The location for medications was locked and secured in the hallway closet. LPA audited 3 out of 3 residents MARs and noticed the Licensee and staff do not have a printable document showing the date and time medication was issued. LPA observed the facility uses an app for charting which was not completed for the 8am meds at 10:38AM. LPA observed the Centrally Stored Medication Log had medication that were not logged or medication that was in the secured container but not listed on the MARs. A deficiency was cited. Laundry Room/Linens and Hygiene Supplies: An adequate supply of linens and hygiene supplies were available for each resident. The laundry room contains chemicals and was securely locked. Backyard : There are no bodies of water in the backyard. There is a covered area with seating for the all the residents. All passageways were free from obstruction. Facility Postings, Fire extinguisher, First aid : There are two (2) charged fire extinguishers in the facility. LPA observed the fire extinguisher was last inspected on 3/13/2025. LPA observed operating smoke detectors and carbon monoxide alarms. LPA observed the facility has not completed a fire/emergency drill since September 2024. A technical violation was issued. The home does not have any firearms and or ammunition. LPA observed required postings including the visitation polices, emergency/disaster contact numbers, complaint procedures, labor laws, and personal rights. LPA observed the licensee did not update or review the LIC610E (Emergency Disaster Plan for Residential Care Facilities For The Elderly. A technical violation issued. LPA observed a complete first aid kit, but licensee did not have a current first aid manual. A technical advisory issued. The facility has a working telephone for resident use. Record Review: LPA reviewed three (3) out of (3) residents files for Admission Agreements, Physician Reports, Needs and Services Plans, Identification and Emergency contact sheet. LPA observed resident file complete and maintained. Staff Files were not readily accessible to LPA during the visit. Administrator stated staff records are being updated. LPA could not verify CPR/First aid training, Health Screening, Personnel Records, Criminal Records Clearances, Background Statements and Fingerprinting, Annual Training. LPA did have a current guardian roster which showed staff working were cleared. A deficiency was cited for staff records not being available. LPA observed the facility did not have a Infection Control Plan available for review. Administrator stated the facility folder was being updated. A technical violation issued. Based on the observations made during today’s visit, three deficiencies, three technical violation, and one technical advisory were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), (LIC809C), (LIC809D), (LIC9102TV), (LIC9102TA) and appeal rights was discussed and provided to Administrator Brett Powell.