Routine inspection·August 8, 2024

On 08/08/2024 at 12:22 PM, Licensing Program Analysts (LPAs) Pang Lee and Holly Williams arrived at the facility to conduct an unannounced annual inspection. LPAs met with Licensee Benilda Lungan. LPAs explained the purpose of today’s visit. Administrator Certificate # is 6003722740 and will expire on 05/04/2025. The current census is 5 with 3 facility staff. This facility is a single story building licensed to served 5 non-ambulatory resident or 4 non-ambulatory and 2 ambulatory residents. Residents’ northeast bedroom is approved for two ambulatory or 1 non-ambulatory residents. LPAs inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room, staff room and outside courtyards of the facility to ensure compliance with Title 22 regulations. It was observed the facility was free of odor, clean and in good repair. LPAs observed client bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPAs toured the kitchen and observed the facility had sufficient seven-day non-perishable food supplies and 2 days perishable food supplies. Hot water temperature was measured at 112.8 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is in the kitchen and was last serviced on 02/08/2024. The last fire drill was conducted on 07/20/2024. LPAs observed the facility has a has a public telephone in the kitchen. Facility thermostat observed at 74 degrees Fahrenheit. LPAs observed sharp knives kept locked and inaccessible to resident. LPAs observed cleaning solution and disinfectants in the garage made accessible to residents in care. LPAs observed the administrator removed the cleaning solution and disinfectants and placed them in a locked cabinets in the garage. Grab bars were observed to be stable and in good repair at this time. Continued LIC 809-C LPAs did not observe the resident shower to have a non-slip mat. During today’s visit administrator went and purchased a new non-skid mat and placed it in the resident shower. LPAs also didn’t observe the facility to have Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) posted in the facility. LPAs checked medication storage and found medication to be locked away and inaccessible to residents. LPAs reviewed and compared 3 out of 5 medication administration record (MAR) along with residents’ medications and it was all complete. LPAs asked to inspect the facility’s first aid kit and it was complete. LPAs requested client and staff files for review. LPAs reviewed 5 out of 5 client files and they were complete. LPAs reviewed 3 staff files and they were complete. LPAs interviewed 2 facility staff and 1 clients during today’s visit. LPAs 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. The following documents will be email to LPA Lee at pang.lee@dss.ca.gov by 08/12/2024 end of day 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) LIC 500 Personnel Report (3) LIC 610 Emergency Disaster Plan (4) Proof of Bond Insurance As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiencies 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, Technical Assistance, Technical Violation and Appeals rights were provided to the facility.