Routine inspection·July 12, 2023

Licensing Program Analyst (LPA) Sabrina Calzada and AGPA Ahmad Rashid, arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the full inspection care tool. Department staff met with John Butuza, Administrator and Maria Butuza, staff. LPA observed (1) resident present and sitting in the kitchen area. Currently, there is (1) resident. and there are no residents on hospice. LPA and Administrator toured the interior and exterior of the facility including the common areas, (6) private resident bedrooms, (3) resident bathrooms, staff room, kitchen, laundry and garage. LPA observed the facility to be clean, in good repair and odor-free. LPA observed each bathroom to have the necessary grab bars, non-skid flooring, paper towels, trash can with lid and 20-second hand-washing poster. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food in the kitchen. Medications are locked in a designated closet, and all toxins are locked in the laundry area. There are no sharps used. LPA observed sufficient PPE/incontinent supplies and linens/towels/blankets. The inside temperature measured 74*F and the hot water measured 120*F. The fire extinguisher was last serviced 3/23/23. One smoke and monoxide alarm was tested and found to be working correctly. Facility conducts quarterly emergency drills. The driveway area is open and unlocked and can be used for emergency exit. There is outside seating on the front porch. LPA and Administrator reviewed ordered medications to those being administered for (1) resident and found no discrepancies. Administrator to obtain an updated medication list to include any medications that have been discontinued. LPA reviewed (2) staff files and found them to contain current First Aid/CPR certification-both staff are fingerprint cleared; however, staff (S1) did not have all required annual training. RCFE Administrator certificate #6016326740- exp 6/3/24. All required postings were observed. Emergency Disaster Plan and Infection Control Plan to be updated and available for staff in binders. An updated copy of liability insurance was obtained (exp 6/24). LPA requested an updated copy of LIC308 and LIC500 be sent to the Department by 7/19/23. Per California Code of Regulations, Title 22, the following (2) deficiencies are being issued on the 9099-D page. Also a Technical Advisory Note is issued. Exit interview. Copy of report and appeal rights provided.