Routine inspection·November 16, 2022

On 11/16/22 at 2:55 pm, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection. Upon LPAs arrival, House Manager Marilyn Carpio was present at facility and notified Administrator Orlando Carpio Jr. that LPA is presence at the facility. LPA was advised that Marilyn Carpio will be able to assist with today’s inspection. Administrator holds current certification #6024159740 and expires on 11/8/2022. The facility is licensed to serve six (6) non-ambulatory residents. Hospice waiver approved for 4 residents. There are currently six (6) residents who reside at this facility of which 1 resident is on hospice. LPA toured the facility with Marilyn Carpio on 11/16/2022 at 3:10 pm. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry area, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. Hot water temperature was observed to be 113.5 degrees Fahrenheit. Facility thermostat observed at 74 degrees Fahrenheit. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed knives and toxins to be locked away and inaccessible to clients. Smoke and carbon detectors were in good repair. Fire extinguisher and first aid kit was up to date. LPA checked medication storage and found medication to be locked away and inaccessible to clients. LPA also conducted the infection control domain tool. Report continued on 809-C The facility mitigation plan was submitted to CCLD, and it was approved on 2/16/2021. Facility has routine symptom screening checks for residents, staff, and visitors. The facility has a symptom check binder for staff, residents, and care staff. Hand Hygiene procedures have been implemented. Facility had Covid-19 posters throughout the facility, and the facility has implemented Covid-19 mitigation plan. Administrator was informed to send updated copies of the following documents to CCL within 15 days: (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 The following deficiencies are cited per California Code of Regulations, TITLE 22. Exit interview was conducted, a copy of this report and Appeal Rights were left at the facility.