Routine inspection·June 5, 2024

On 6/5/24 at 10am, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced annual required visit, with the use of the CARE Inspection Tool. LPA initially met with a staff on duty and explained the purpose of today’s visit. The facility administrator, Angelita Dayoan, was informed of the visit and arrived shortly after. The facility is currently licensed to serve 6 non-ambulatory elderly residents The facility is approved for 5 hospice residents. Present during this visit, there were 6 residents in care with 2 staff on duty. At 10:30am LPA and Administrator inspected the facility’s physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, 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. Outside of the facility was observed to be cleaned and clear of obstructions. Swimming pool in the backyard was observed to be fenced and locked and inaccessible to residents in care. Additionally, LPA observed outdoor furniture for residents’ use and area for outdoor activities. Entrance, exits and hallways were observed to be clear of obstructions. LPA observed 6 private resident bedrooms and 3 bathrooms for resident use. LPA observed beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage for the resident's personal belongings. Bed linens, comforters, and bath towels were adequately stocked during the visit. Bathrooms were 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 76 degrees F. Water temperature in one of the bathroom was measured at 119 degrees F. The fire extinguisher located by the exit to the garage was serviced on 5/29/24. Smoke detectors and carbon monoxide were tested and found to be operable during this visit. {Con't to LIC 809-C...} {...Con't from LIC809} Medication storage area was observed to be locked and inaccessible to residents in care. Medications were reviewed for accuracy. First aid kit was observed to have adequate supplies and accessible to staff. The facility maintains for each resident Centrally Stored Medication, Destruction Record and PRN Log. LPA observed personal rights, resident council and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s sufficient equipment and supplies to meet activity program needs of residents in care. During this inspection, LPA conducted an audit of facility files, 6 resident files, and 4 staff files for regulatory compliance. All staff noted on LIC 500 have criminal background clearances and associated to this facility. LPA attempted 2 resident interviews and 2 staff interviews. 6 out of 6 Resident files reviewed contained all Facility maintain resident records including updated admission agreements, medical assessments, and updated appraisal forms as required. 4 out of 4 staff files reviewed contained all required contents including health screening, TB results, current first aid/CPR, and initial and ongoing required training. Facility’s liability insurance is current per regulatory requirements. Facility conducts quarterly fire drills. LPA requested an updated copy of current liability insurance, LIC 308 and LIC 500. Per California Code of Regulations (CCR), Title 22, no deficiencies were observed. An exit interview was held, and a copy of the report was given.