Routine inspection·April 4, 2024

On 4/4/24 at 10am Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced annual required visit. LPA initially met with a staff on duty and explained the purpose of today's visit. The facility Administrator, Annie Lyn Rodriguez, arrived shortly after. Present during this visit, there were five residents in care with one staff on duty. At 10:15am, LPA and Administrator inspected the facility’s physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathroom, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. The facility is a one-story structure located in a residential neighborhood. There were no bodies of water on the premises at this time. Outside of the facility was observed to be clean and clear of obstructions. Additionally, LPA observed outdoor furniture for clients’ use. During the inspection outside, LPA observed the side gate door to require force to open. LPA also observed the bolt securing the gate to the wall of the house was damaged causing the door to be stuck. Per interview, the door was damaged by ambulance personnel. Per Administrator, they will have it repair. Other entrances, exits and hallways were observed to be clear of obstructions. LPA observed three (3) resident bedrooms (all shared), and two (2) bathrooms for resident use. There is one staff room in the facility. LPA observed beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage for the client’s personal belongings. Bed linens, comforters, and bath towels were adequately stocked during the visit. Bathroom is observed to be operational and adequately supplied, including with grab bars and non-skid flooring. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were locked and not accessible to residents in care. The kitchen was inspected, and sufficient 2-day perishable and 7-day non-perishable food was maintained adequately. Room temperature was maintained in the facility at 75 degrees F. Water temperature in the bathroom was measured at 107 degrees F. One fire extinguisher was last serviced on 3/12/24. Smoke detectors/ carbon monoxide combo were tested and found to be operable during this visit. {Con't to LIC809-C} Medication storage area was observed to be locked and inaccessible to residents in care. Medications were reviewed for accuracy for two residents. First aid kit was observed to have adequate supplies and accessible to staff. The facility maintains for each client Centrally Stored Medication, Destruction Record and PRN Log. LPA observed the facility's infection control practices. All mandated inspection control posters were posted. LPA observed personal rights poster. Facility has appropriate internet access available for resident use. LPA observed sufficient equipment and supplies to meet activity program needs of residents in care. During this visit, one resident was watching TV in the common area. Other residents were in their bedrooms. During this inspection, LPA conducted an audit of facility files, five (5) resident files, and four (4) staff files for regulatory compliance. All four staff have criminal background clearances and are associated to this facility. All four staff files reviewed contained required contents including health screening, TB results, current first aid/CPR, and initial and ongoing required training. During resident file review, LPA discovered that 1 of 5 resident file does not contain the following required forms: admission agreement and pre-admission appraisal. Further review of resident files revealed that 1 of 5 resident have a restricted health condition. Additional review revealed that facility does not have a plan of care and staff training was not completed prior to working with the resident with restricted health condition. Facility’s liability insurance is current per regulatory requirements. LPA reviewed facility’s disaster plan to ensure regulatory compliance. LPA observed that facility conducts quarterly fire drills. LPA was provided updated copy of LIC 308, LIC 500, 1 and liability insurance. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. An exit interview was conducted with Administrator Annie Lyn Rodriguez, and a copy of this report was provided.