Routine inspection·March 14, 2023

On 03/14/2023 at 8:25 AM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with care staff Ferdinand Sadaya and explained the purpose of the visit. Care staff Ferdinand called administrator Lionel Nunez and administrator instructed care staff Ferdinand to assist with today’s visit. Administrator certificate # is 60002516735 and will expired on 11/17/2023. The facility has one main Covid-19 screening entry point. The facility has Covid-19 posting throughout the facility. The furniture is spaced six feet apart, and the facility does daily cleaning. The facility has a 30-day supply of PPE. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, client bedrooms, client bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. This facility is a single story building licensed to serve four (4) residents of which (1) may be non-ambulatory. The facility is also approved for hospice waiver for (1) client. 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 observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 119.0 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. Fire extinguisher last serviced 03/11/2022 which is not up to date. Facility thermostat observed at 70 degrees Fahrenheit. LPA Lee checked medication storage and found medication to be locked away and inaccessible to clients. First aid kit was checked and is complete. LPA Lee requested client and staff files for review. LPA Lee reviewed (2) client files and (3) staff files, including criminal record clearances. 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. LPA Lee verified staff training for staff file reviews. Continue The following documents shall be submitted to LPA Lee by 03/21/2023 by close of business 5:00PM. (1) LIC308 Designation of Administrative Responsibility (2) LIC500 Personnel Report (3) LIC610 Emergency Disaster Plan (5) Proof of Current Liability Insurance 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 the LIC 809 reports, LIC 809-D Page, and Appeals rights were provided to the facility.