Post-licensing visit·December 19, 2024

On 12/19/24, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to conduct a post-licensing visit. LPA was greeted by staff member, Juan Ramirez and explained the purpose of the visit. LPA asked that staff call the Facility Designated Administrator (FDA) Noel Estillore to inform them that CCL was present at this time. It was learned that Noel is no longer employed at the care home. Care staff then called licensee Chris Faamausili and a brief interview was conducted via telephone with the licensee Chris. LPA Lee explained the purpose of the visit. Per interview with licensee Chris will be the designated administrator. Chris also holds an active administrator certificate # 7011766740 and is valid until 06/08/2026. Licensee Chris will email LPA Lee documents to appoint himself as the administrator to the facility. Current census was 2. This facility is licensed to served 6 non-ambulatory residents in room 1, 2, and 3. The facility second floor and detached garage are not for resident’s use. This facility also holds a hospice waiver for 6. There are currently no residents on hospice at this time. LPA reviewed 2 out of 2 resident files and 2 staff files. 1 out of 1 resident file is missing appraisal and needs and service. Furthermore, 1 out of 1 staff did not have a health screening and TB. Upon arrival, LPA Lee observed a strong smell of feces in the facility. A tour of the facility was conducted. LPA Lee observed feces on resident’s toilet seat. The feces appeared old and dried. Hot water temperatures were taken to ensure it was in the regulation of 105-120 degrees and it measured at 117.1 * F. Carbon monoxide and smoke alarms were present and were in working condition. Common areas for resident use were toured. Furniture and furnishings were observed to be present and in compliance. Grab bars and non-skid mats were present and functional. Resident bedrooms were toured. Furniture and furnishing were observed to be present and in good condition. A linen closet was located in the hallway and had sufficient number of linens at this time. The kitchen area was toured. Facility freezer and refrigerator showed to be functional. Continued LIC 809-C LPA Lee observed both the refrigerator and pantry locked and made inaccessible to residents in care at this time. LPA observed 2-day perishable and 7-day nonperishable food supply and it was sufficient at this time. The fire extinguisher, located in the kitchen area, was serviced on 12/18/24 and is in compliance at this time. Second floor of the facility was toured. This facility has a centralized medication cabinet that was observed to be locked and made inaccessible to the residents. First aid kit was observed to be present and contained all the required components at this time. Toxins were observed not locked and made accessible to residents in care. Exterior grounds of this facility were toured. Perimeter fence and gates were observed to be functional and in good repair at this time. Detached garage was also toured. Per California Code of Regulations (CCR) - deficiencies are being cited on the attached LIC 809 -D. Appeal Rights provided. Failure to correct deficiencies may result in civil penalties. An exit interview was held with staff Juan Ramirez and a copy of the report was provided.