Routine inspection·February 9, 2024

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct an annual inspection utilizing the full CARE tool. LPA met with caregiver and explained the purpose of the visit. Caregiver contacted Administrator who stated he will be coming to the facility shortly. Today's census is four residents in care, LPA and Caregiver conducted a tour of the facility. Areas toured included but not limited to: four residents rooms, two bathrooms, and the common areas. After inspection was conducted, Administrator arrived to the facility to discuss deficiencies with LPA. During inspection, LPA observed medications to be in four out of four residents rooms. LPA observed cleaning supplies such as windex and clorox spray to be placed throughout the facility, easily accessible to residents in care. LPA observed fire extinguisher to last be serviced on 11/30/2022. LPA informed Administrator fire extinguishers should be serviced annually to ensure it is in good condition. LPA observed power tools to be in the garage, LPA informed Administrator dangerous items should be locked and secured at all times. LPA observed S1 is not have a fingerprint clearance at the facility. LPA observed R4's room to be missing a bed, LPA informed Administrator an exception request should have been submitted as no bed in the room is noncompliance to California Code Regulation, Title 22. LPA conducted a resident file review and observed R1 and R2's LIC 602 to be incomplete. LPA observed R3 and R4 to have no LIC 602 on file as Administrator was not aware that all residents are to have the following documents. LPA conducted a personnel file review and observed no documentation of staff training. Additionally, LPA observed only one out of seven staff to have First Aid and CPR training. CARE inspection tool completed and deficiencies was observed. Please see LIC 809-Ds. Today's visit, civil penalties assessed. LPA requested a copy of facility's liability insurance, LIC 500 and LIC 308 by Monday February 12, 2024. Exit interview conducted and a copy of the report and appeal rights was emailed to Administrator.