Routine inspection·January 30, 2023

Licensing Program Analyst (LPAs) Pang Lee and Avelina Martinez arrived at the facility to conduct an unannounced annual inspection on 1/30/2023. LPAs met with Justice Ehimamiegho and explained the purpose of the visit. Administrator Justice Ehimamiegho assisted with today’s visit. LPAs 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. This facility is a single story building licensed to serve four (6) non-ambulatory residents and (2) hospice waiver. LPAs observed the facility to be free of odor and clean. LPAs observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. The facility has one main Covid-19 screening entry point. The facility has Covid-19 posting throughout the facility. The furniture is spaced six feet apart, and the facility does daily cleaning. The facility has a 30-day supply of PPE. LPAs observed an insufficient supply of food in the facility. The facility has three refrigerators designated for resident food use. One refrigerator was locked, which had very little food and a knife and insulin medication was kept in that fridge. The second resident refrigerator was empty, and the third refrigerator only had two gallons of milk. In addition, the facility water temperature measured at 95 degrees. Moreover, hallway light fixture was not in good repair and is missing a light bulb. Bedroom two and four were missing electric plate covers. The facility smoke and carbon detectors are in good repair, and the fire extinguishers are in good repair. The facility has a first aid kit, and the medications are stored in a locked cabinet. LPAs toured the exterior of the facility. The facility’s exterior fence is not in good repair. The patio canopy is not in good repair, and there are cigarette butts on the grass area. LPAs reviewed two resident files and three staff files. The resident files were up to date, and Staff 1 (S1) does not have a staff file. Continued... The following documents shall be submitted to LPA Lee by 02/10/2023 by close of business 5:00 PM. (1) LIC308 Designation of Administrative Responsibility (2) LIC500 Personnel Report (3) Copy of Administrator Certificate (4) LIC610 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 809 D page. An exit interview was conducted, and a copy of these 809 reports, 809 D Page, and Appeals rights were provided to the facility.