Routine inspection·November 7, 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 Administrator Noelia Garcia and was granted entry to the facility. At the time of the visit, there were three (3) staff present and six (6) residents present. The facility is a four (4) bedroom, two and half (2.5) bathroom home with a kitchen, a dining area, a living room area, and an attached garage. The facility is a Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents, one (1) of the six (6) residents may be bedridden. The current census is six (6) residents. LPA was accompanied by Administrator to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: 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 observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperature in the bathroom to be at 116.4 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCL complaint poster, labor laws, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside the medication cabinet in the kitchen inaccessible to residents. Overall, the facility is clean and in good repair. Food Service: Non-perishable and perishable food supply is sufficient for the residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed three (3) residents files for admission agreements, updated physician reports, and needs and services plans. LPA discovered that one (1) out of three (3) residents did not have an updated physician’s report/medical assessment. LPA discovered that three (3) out of the three (3) residents did not have needs and services plans in their files. The facility will be issued a type B deficiency for not having needs and services plans for the residents. The facility will be issued a type B deficiency for not having an updated physician’s report/medical assessment. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Medications/MARs records were audited and appeared to be dispensed and logged appropriately. Based on the observations made during today’s visit, two (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) and LIC809D were discussed and provided to Administrator Noelia Garcia, along with a copy of the appeal rights.