Routine inspection·August 24, 2023

On 08/24/2023 at 8:00 AM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with direct care staff, Teresa Autencio and her husband Geronimo, who then called administrator, Christine Torres. Administrator, Christine arrived approximately one hour later. LPA Lee explained the purpose of the visit. Administrator, Christine assisted with today’s visit. Administrator certificate # is 6042576740 and will expire on 10/23/2024. The current census is 6 with 2 facility staff. This facility is a two story building licensed to serve three (3) non-ambulatory residents and three (3) ambulatory residents. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor and clean. LPA Lee observed resident room #4 intercom box not in good repair with exposed wired. 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. Hot water temperature was measured at 127.8 degrees Fahrenheit in resident bathroom sink, which is not within the required regulation of 105 to 120 degrees Fahrenheit. Fire alarm and carbon monoxide detectors are in compliance with fire safety. LPA Lee observed one fire extinguisher in the kitchen without a service tag or a receipt of purchased on the fire extinguisher. LPA Lee also observed two fire extinguisher in the upstairs hallway. The second fire extinguisher also did not have a service tag and receipt attached to it. The third fire extinguisher service tag was dated on 09/04/2018. LPA Lee observed the facility has a has a public telephone in the common room and the facility have the required posters posted. The facility has infection control plan and has an emergency disaster plan. Facility thermostat observed at 74 degrees Fahrenheit. LPA Lee checked medication storage and found medication to be locked away and inaccessible to clients. Continued LIC 809-C LPA Lee reviewed 3 out of 3 medication administration record (MAR) and it was complete. LPA Lee observed one resident medication is not in it's original box. First aid kit was checked and is complete. LPA Lee requested residents and staff files for review. LPA Lee reviewed 6 out of 6 resident files and 6 out of 6 resident file was not complete. LPA Lee reviewed 3 out of 6 staff files and 3 out of 6 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. The following documents were given to LPA Lee during today's visit. (1) LIC 308 Designation of Administrative Responsibility (2) LIC 500 Personnel Report (3) Copy of Administrator Certificate (4) LIC 610 Emergency Disaster Plan (5) Proof of Current Liability Insurance 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, LIC 9102 Technical Violation and Appeals rights were provided to the facility.