Routine inspection·December 28, 2023

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Caregiver Alexander Angulo and was granted entry to the facility. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of six (6) non-ambulatory residents, one (1) resident may be bedridden. The current census is five (5) residents. LPA was accompanied by Caregiver to conduct a general overall inspection, which included, but was not limited to, the following: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to interior and exterior passageways. The facility is maintained at a comfortable temperature. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA measured and observed the water temperature in the bathrooms to be at 129.3 degrees F. The facility will be issued a deficiency for not having the water temperature within the correct temperature range. LPA observed sufficient furniture and lighting throughout the facility. The facility has residents with a condition that requires auditory devices on the facility exit doors. The facility does not have working auditory devices on the exit doors in the living room, laundry room, staff room #1, bedroom #2, and bedroom #3. The facility will be issued a deficiency for not having auditory alarms on the facility exit doors. LPA found holes in the ceiling and the wall covered with trash bags and tape in the staff room #1. LPA found holes in the ceiling in the laundry room covered with trash bags and tape. LPA was informed by the Administrator that the holes were made in the wall and ceiling to add fire sprinklers, but the Administrator has since decided not to complete the addition of the fire sprinklers. The facility will be issued a deficiency for having holes in the walls and the ceiling. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, and the CCL complaint poster were posted in a common area. The facility does not have disaster plan, LIC610E posted, and the facility has not conducted a disaster drill since 1/10/2021. LPA was informed by the Administrator that they knew they did not conduct a recent disaster drill or have a disaster plan posted in the facility. The facility will be issued deficiencies for not posting a disaster plan and for not conducting a disaster drill quarterly. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident and staff files. Medications are kept inside the hallway cabinet inaccessible to residents. Non-perishable and perishable food supply is sufficient for the residents in care. Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. LPA reviewed six (6) residents files for admission agreements, updated physician reports, and needs and services plans. LPA found that Resident’s R1, R2, R4, and R5 do not have needs and services plans, LIC625. The facility will be issued a deficiency for not having needs and service plans for the residents. LPA reviewed three (3) staff files for First Aid/CPR certifications, criminal record clearances, trainings, and health screenings. Based on the observations made during today’s visit, six (6) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D forms, and LIC811 were discussed and provided to Caregiver Alexander Angulo, along with a copy of the appeal rights.