Routine inspection·September 18, 2023

On 9/18/23 at approximately 10am Licensing Program Analyst (LPA) Jennifer Fain arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Ma Magnolia Tolon and explained the purpose of the visit. LPA inspected the 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. Facility has 6 bedrooms and 5 bathrooms for resident use. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 1 ambulatory resident and 5 non ambulatory residents. Facility Observation: Upon entry the residents were in the common area or in their rooms watching tv or on personal devices. Staff checked in with residents every 20- 30 minutes. Lunch was served at the kitchen table or in resident rooms. The lunch menu was beef with potatoes and fruit. 2 families visited residents in the morning. LPA observed staff working with residents on their physical therapy. During this inspection 6 resident files and 2 staffing files were reviewed for regulatory compliance. Staff files contained required contents including staff training requirements. 3 of 6 Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Facility has 1 resident with half bedrails with physician orders in place. Water temperature in common bathroom reads 124.5F* with “caution hot water” signs in place. Temperature on the heating and air unit read 77*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were tested and in working order. Fire extinguisher was serviced 5/15/23. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and was accessible to staff. Facility does not contain any bodies of water. LPA observed personal rights, resident council and complaint information posted. Facility has appropriate internet access available for resident use. Facility conducts quarterly fire drills. LPA requested and received an updated copy of LIC 308, 309, 610E and LIC 500. 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 with Ma Magnolia Tolon, and a copy of the LIC 809 reports, LIC 809-D pages, and Appeals rights were provided.