Routine inspection·July 28, 2023

On 07/28/2023 at 1:45 PM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with Designation of Administrative Responsibility, Glenda Molinyawe and explained the purpose of the visit.. Glenda assisted with today's visit. Administrator certificate # is 6008950740 and will expire on 10/23/2023. The current census is 6 with three facility staff. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, residents bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. This facility is a single story building licensed to serve five (5) non-ambulatory residents, one (1) bedridden resident and approved for 2 hospice residents. 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. Hot water temperature was measured at 109.6 degrees Fahrenheit in resident bathroom sink. Fire extinguishers, smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher was last serviced on 09/01/2022. The last fire drill was conducted on 07/19/2023. LPA Lee observed the facility has a public telephone in the common room and two in the kitchen. The facility have the required posters posted. The facility has infection control plan and has an emergency disaster plan. Facility thermostat observed at 73 degrees Fahrenheit. LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. LPA Lee reviewed 3 out of 6 medication administration record (MAR) and it was complete. First aid kit was checked and is complete. LPA Lee requested resident and staff files for review. LPA Lee reviewed 6 out of 6 resident files and 3 out of 3 staff files and they all were complete. 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. Continued LIC 809-C The following documents will be emailed to LPA Lee by 07/31/2023 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 Per California Code of Regulations, Title 22, no deficiencies were observed during today’s visit. A copy of this report was provided to the facility.