Routine inspection·May 21, 2021

Licensing Program Analyst (LPA) Anthony Tuck Kevin Gould Island arrived to conduct an unannounced annual/random inspection on 05/21/2020. LPA met with Licensee Emilita Madriaga and explained the purpose of the visit. Emilita Madriaga is also the Administrator and holds certificate #6004809740 that expires on 07/17/2021. This facility is a single story building licensed to serve six (6) ambulatory residents. LPA toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 105 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke detectors are (blank) in compliance with fire safety. Fire extinguisher last serviced July 13 of 2020. Thermostat was 68 degrees Fahrenheit. LPA observed centrally stored medications and toxins was kept locked and inaccessible to clients. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed resident files,. LPA reviewed associations to the facility. First aid kit was checked and is complete. The following forms need updating and submitted to CCLD by 05/24/2020: LIC 308 LIC 500 LIC 610E Copy of current administrator certificate continued on 9099C LPA learned that the facility currently has 2 residents that are non ambulatory. The facility does not have a fire clearance for non ambulatory residents. Per California Code of Regulations, Title 22 Division 6, Chapter 8, Type A deficiencies are being cited today in violation of California Code of Regulations and follows on 809D. Exit interview held with Emilita Madriaga and a copy of report given at the conclusion of the visit.