Routine inspection·August 9, 2024

On 08/09/2024 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct an annual inspection/1 year required visit. LPA met with Administrator Favieruth Jimeno, and explained the purpose of the visit. The facility is licensed to serve (6) non ambulatory, of which 1 may be bedridden in bedroom #1 or #4 only. The facility has an approved hospice waiver for 2. The facility currently has 4 residents receiving hospice services. There are 2 exception requests that were submitted. The home is a single story structure consisting of 4 bedrooms and 2 bathrooms, kitchen, garage, backyard, dining area and family room. There are no pools or bodies of water on the premises. The hot water temperature was tested and measured at 109-110 degrees Fahrenheit. The facility was observed to be clean and clutter free. The facility was observed to have the required postings such as personal rights, CCL complaint and LTCO poster. The food supply was adequate as the facility was observed to have a 2 day supply of perishable and a 7 day supply of non perishable food items. The medications and sharp objects in the locked cabinet located inside the kitchen, The facility has a fully charged fire extinguisher, and the smoke and carbon monoxide detectors were tested and were observed to be operable. The facility is required to conduct the emergency disaster drills on a quarterly basis, the last drill was conducted on 04/20/24. Deficiency cited, as the drill should have been conducted in July 2024. A records review was conducted on both staff and resident files, each file reviewed (3) residents were observed to have a medical assessment, and appraisals. Staff records reviewed (3) were observed to have current CPR certification, with all staff having obtained proper fingerprint clearance and to be associated to the facility. The Administrator was observed to have a valid administrator certificate, which expires April 2025. The facility has an ample supply of personal protective equipment. There are no known guns or ammunition on the premises. LPA conducted a file review and as of 08/01/24 the annual licensing fees have not been paid, as they are due by 08/21/24. During today's visit LPA followed up regarding the fees, and provided the PIN so that the fees could be paid electronically. Based on today's inspection a citation will be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted and a copy of this report, appeal rights, and proof of corrections form (LIC9098) was provided to Administrator Favieruth Jimeno.