Routine inspection·September 23, 2024

Licensing Program Analysts (LPAs) Kathleen Banrasavong and Armando Perez, along with CDSS’s Program Clinical Consultant, Dennis Bagayawa arrived unannounced to conduct an annual inspection. Upon arrival LPAs were greeted by facility staff and granted entry. LPAs began inspection with introduction and visit purpose. Upon arrival LPAs learned that seven (7) residents live at this facility. There was two (2) staff members present. The Administrator, Telecia Cooke was advised of the annual and came to conduct and completed the facility tour. Client Records/Incident Reports/Clients Rights Information: LPAs reviewed client records. Seven (7) records were reviewed. LPAs reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/ Staffing/ Administration : LPAs reviewed employee records. Two (2) records were reviewed. LPAs reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Telecia Cooke, Administrator’s certificate expiration date was 04/08/2022. The Administrator submitted her renewal to the Department of Social Services on 07/11/2023. Food Service: Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements: LPAs toured the facility inside and outside. LPAs observed the facility to be clean and in good repair. The facility is maintained at 76 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 108.0 degrees F. Laundry is done in the garage. There is a locked location for storing laundry soap, cleaning supplies and chemicals in the closet in the garage. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPAs dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There are one (1) secured fireplace at this facility. There are zero (0) pools at the facility. There are two (2) secured gates that has a self-latching lock located on the northwest and northeast side of the house. LPAs observed emergency supplies and one (1) first aid kit. The last emergency fire drill was conducted on 06/31/2024. Infection Control: The LPAs observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPAs observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPAs reviewed the facility's infection control plan which met department requirements. LPAs reviewed staff records and found that staff had infection control training. Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPAs reviewed medication logs and observed that they were dispensed accurately. LPAs made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPAs observed nine (9) dual smoke detectors and two (2) carbon monoxide detectors throughout the facility. There were three (3) fire extinguishers on site, date charged was 05/30/2024. Pursuant to Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to Administrator, Telecia Cooke.