Routine inspection·September 15, 2023

On 09/15/2023 at 12:00 PM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with administrator, Veronica L Dawson-Lucy. LPA Lee explained the purpose of the visit. Administrator assisted with today’s visit. Administrator Certificate # is 6049136740 and will expires on 10/07/2024 . The current census is 9 with 2 facility staff. This facility is a single story building licensed to serve twelve (12) ambulatory residents only. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee observed sufficient seven day non-perishable and two day perishable food supplies. LPA Lee observed chemical under the kitchen sink made accessible residents. Hot water temperature was measured at 116.1 degrees Fahrenheit in kitchen sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. LPA Lee observed both resident bath missing a non-slip mat. Fire extinguishers, smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher was last serviced on 08/25/2023. LPA Lee observed the facility has a has a public telephone in the dining area and the facility have the required posters posted. The facility has infection control plan and has an emergency disaster plan. Facility thermostat observed at 72 degrees Fahrenheit. LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. LPA Lee reviewed 5 out of 9 residents medication and it was learned that the facility doesn't use Medical Administration Record (MAR) sheets or Centrally Stored Medication Destruction Record (CSMDR). Continued LIC 809-C LPA Lee advised the administrator that the facility needs to have a plan for distributing medications to each resident when licensing comes out to the facility to check on residents medications. First aid kit was checked and is complete. LPA Lee requested residents and staff files for review. LPA Lee reviewed 5 out of 9 resident files and 2 out of 2 staff files and they were all incomplete. LPA Lee reviewed staff criminal record clearances and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. The following documents will be email to LPA Lee ( pang.lee@dss.ca.gov ) by 09/22/2023 by 5:00 PM by end of day: (1) LIC 308 Designation of Administrative Responsibility (2) LIC 500 Personnel Report (3) Copy of Administrator Certificate (4) LIC 610 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 LIC 809 D page. An exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.