Routine inspection·April 3, 2025

On 04/03/2025 at 8:38am, Licensing Program Analyst (LPA) Pang Lee and Shakaricka Hughes arrived at the facility to conduct an unannounced annual inspection. LPA Lee and Hughes met with caregiver Jose Pasion and explained the purpose of the visit. Jose called the facility designated administrator to inform that CCLD was present in the facility. The current census is 4 with 3 facility staff. This facility is a single story building licensed to serve (2) non-ambulatory residents in bedrooms 1 and 3. (2) ambulatory residents. LPA's inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA's observed the facility to be free of odor, clean and in good repair. LPA's observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA's toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. While touring the kitchen area, LPA's observed a staff's eye drop medication inside the refrigerator unlocked. Hot water temperature was measured at 118.5 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety.  The fire extinguisher is located and in the common area was last serviced on 12/06/2024. LPA's observed the facility has a public telephone in the common area and the facility has the required posters posted. Continuation 809-C Facility thermostat was observed at 74 degrees Fahrenheit. LPA's observed toxins located in the hallway closet and kept locked and inaccessible to residents. LPA's observed sharp knives kept locked in the kitchen and inaccessible to residents. LPA's checked medication storage and found medication to be locked away and inaccessible to residents. LPA reviewed 2 out of 4 residents medications and the medication administration record (MAR) was complete. The first aid kit was checked and contained the required components. LPA's requested resident and staff files for review. LPA's reviewed 4 out of 4 resident files and they were complete. LPA's reviewed 3 staff files, and it was complete. LPA's 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. The following documents was provided during today's visit: (1) Copy of administrator certificate (2) Proof of Current Liability Insurance (3) LIC 500 Current Personnel Report The following documents will be email to LPA by 04/10/2025 end of day 5:00 PM: ( 1) LIC 308 Designation of Administrative Responsibility (4) LIC 610 Current Emergency Disaster Plan As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiency 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.