Routine inspection·May 3, 2023

Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection on 05/03/2023 at 8:40 AM, LPA Lee met with Licensee/Administrator Edna Clegg and explained the purpose of the visit. Administrator certificated number # 6017600740 expires on 07/15/2024. Administrator assisted with today’s visit. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. The facility has one public telephone one in the kitchen area. The facility has the required posters posted in the facility. This facility is a single story building licensed to serve ten (10) residents. LPA observed one of the cabinet in the kitchen is broken. LPA observed one resident’s room having urine odor. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee observed sufficient seven-day non-perishable and two-day perishable food supplies. The resident bathroom water temperature measured at 107.6 degrees Fahrenheit which is within the required regulation of 105 to 120 degrees Fahrenheit. LPA observed two bathrooms with no nonskid mats and having urine odor with urine stain on the wall and around the toilet. Fire extinguishers and smoke detectors are in good repair. Fire extinguisher was last serviced on 07/14/2022. LPA observed the carbon monoxide off the wall and on top of a shelf and not working. Facility thermostat observed at 63 degrees Fahrenheit. LPA checked medication storage and found medication to be locked away and inaccessible to clients. LPA reviewed 4 out of 8 Centrally Stored Medication and Destruction Report and it was not complete. First aid kit was checked and is complete. LPA Lee requested client and staff files for review. LPA reviewed 4 out of 8 client files and 1 out of 4 resident file was not complete. LPA reviewed 3 out of 6 staff files and 3 out 3 staff files were not complete. LPA Lee reviewed staff criminal record clearances and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. Continued LIC 809-C The following documents will be emailed to LPA Lee by Licensee by 05/08/2023 by 5:00 PM of business day. (1) LIC 308 Designation of Administrative Responsibility (2) LIC 500 Personnel Report (3) Proof of Current Liability Insurance (4) LIC 610 Emergency Disaster Plan (5) Current Administrator Certificate As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiencies can be found on the LIC 809-D page. An exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D page, Technical Advisory (TA) and Appeals rights were provided to the facility.