Routine inspection·January 6, 2025

On 01/06/25 at 8:30 AM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with direct care giver Cynthia Navarro who then called the facility designated administrator (FDA) Carmen Navarro to informed that CCLD was present in the facility. FDA arrived approximately 30 minutes later. Administrator assisted with today’s visit. The current census is 5 with 2 facility staff. This facility is a single story building licensed to serve six (6) non-ambulatory residents. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. 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 toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 112.3 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Grab bars and non-slip mat were observed to be stable and in good repair at this time. Smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in common area and was last serviced on 01/03/25. The last fire drill was conducted on 12/20/24. LPA Lee observed the facility has a has a public telephone in the kitchen and the facility has the required posters posted. Facility thermostat was observed at 72 degrees Fahrenheit. LPA Lee observed toxins located in resident bathroom cabinet and in the laundry room and they both were not kept locked and made accessible to residents at this time. LPA Lee observed sharp knives kept locked in the kitchen cabinet and inaccessible to residents. Continued LIC 809-C LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. LPA Lee reviewed and compared 3 out of 5 medication administration record (MAR) and it was complete. The first aid kit was checked and contained all the required components. LPA Lee requested resident and staff files for review. LPA Lee reviewed 5 out of 5 resident files and they were not complete. 2 out of 5 resident files did not have a current Individual Progress Plan (IPP) and the most current IPP in the file are dated for 2022. LPA Lee reviewed 3 staff files and it was not complete. Staff 1 (S1) is missing 20 hours of annual training for 2024 and S2 did not have any documentation of dementia training prior to caring for dementia residents in the facility. 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. The following documents will be email to LPA by 01/10/25 end of day 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report (7) LIC 309 Administrator Organization As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiency 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, and Appeals rights were provided to the facility.