Routine inspection·April 11, 2024

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced required 1 year annual inspection. LPA met with direct care staff and explained purpose of visit. Administrator's Certification 1/3/2025. LPA and direct care staff toured the interior and exterior of the facility including common areas, resident bedrooms, resident bathrooms, staff room, kitchen, dining room, laundry area, and garage. LPA observed the facility to be clean and in good repair and to have sufficient furniture and lighting throughout. LPA observed sufficient seven day non-perishable and two day perishable food supplies. LPA observed locked sharps locked cabinet designated for medications. Chemicals (2 bottles of bleach and 1 gallon of bug spray) are not locked up in back area of property. LPA observed grab bars and non-skid flooring in all bathrooms. LPA observed locked toxins in the laundry room and a supply of linens/towels/blankets on hand. Fire extinguishers was last inspected 2/28/2024. The facility conducts fire/disaster drills with residents on 2/9/2024. Smoke/monoxide alarms are working order. LPA observed a complete First Aid kit on site and measured the hot water at 113.2 *F in the bathroom. LPA observed all doors to have alarms. LPA observed seating on patio, a locked shed, and two gates that were unlocked and accessible. There were tree branches and debris in back of property. Workshop was locked with a cat looking out. Facility sketch shows workshop, but licensee stated mom stays there occasionally. Two old refrigerators, two washers, and two dryers which need to be removed. LPA reviewed five resident files and three staff files, including criminal record clearances. A review of staff records indicates not all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. LPA requested the following updated documents for community care licensing to be submitted via email by April 16, 2024: Updated Facility Sketch, New Fire Clearance, LIC 308 Designation of Administrator, LIC 500 - Personnel Report, LIC 610E Emergency Disaster Plan, Copy of Administrator's Certificate, and Copy of Liability Insurance. ruth.wallace@dss.ca.gov Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiencies are being cited. See 809-D's for citations. Immediate civil penalty of $500.00 was issued to facility. Failure to correct the deficiencies by the noted due date may result in an additional penalty being assessed. Exit interview conducted with direct care staff. Copy of reports and (LIC 811 Confidential Names) left at facility.