Routine inspection·November 3, 2021

On 11-3-21 at 8:30am Licensing Program Analyst (LPA) Tirzah Hubbard arrived unannounced to conduct a Required – 1 Year inspection. LPA contacted the facility to ask follow up questions in regard to Covid-19. LPA left a message for call back at the facility. LPA attempted to enter the facility. LPA observed movement in the facility, but no one would come to the door to let LPA in for visit. LPA contacted the facility Licensee to ask follow up questions for Covid-19 symptoms. LPA notified the licensee that neither staff of the facility opened the door. LPA Hubbard had to wait outside for 45 minutes before entry. LPA proceeded to approach the facility to conduct the Annual after the facility was cleared. All required COVID measures were observed. LPA observed S1 wearing mask upon entry. S1 took the temperature of LPA and asked Covid-19 screening questions. LPA were allowed entry into the facility that is licensed to serve a total capacity of 6 clients. LPA interacted with a random number of residents during this visit. The physical plant was toured inside and outside to ensure the safety of the residents. All required furniture were observed. LPA observed residents engaging in activity, wearing a mask and practicing social distancing. LPA observed the facility conducts fire drills monthly. All bedrooms contained a dresser, bed, and night stand. The flooring of the facility is in the process of repair a this time. The flooring of the kitchen is in disrepair a this time. LPA observed in kitchen area the hood over stove accumulating grease and dirt. Licensee state this will be replaced by 11-12-21.LPA observed in bedroom 1 leaks in the ceiling. Licensee Helen stated the leak has been there since October 24, 2021 from the previous heavy rain. Licensee stated someone will be coming out on 11-3-2021 to fix the ruff and walls of the room. Licensee stated the ruff inspector is currently at their home working on their ruff down the street of the facility. The repair for facility will happened today on 11-3-21 when they are finished at my home. Licensee was not able to provide proof of invoice of repair in process. LPA stated proof of correction can be sent via email by pictures by date 11-5-21. Licensee stated, R1 has still been sleeping in the room and will relocate her today on 11-3-21 until it is fixed. LPA observed in bathroom 2 faucet knob in disrepair containing plastic wrapped around with rubber bands not working. Residents are not able to use the faucet. Licensee did not provide reasoning of why the faucet has been broken. LPA observed the thermostat temperature inside the facility hallway was measured at 75 *F which is within the require range of 68 degrees F (20 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat the maximum shall be 30 degrees F (16.6 degrees C) less than the outside temperature. The hot water was measured at 108 *F which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C) as per Title 22 regulations. LPA observed the centrally stored medications area to be locked and inaccessible to clients. LPA observed 3 of 3 medications counted properly labeled and stored, matching medication administration records (MAR). The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, central heating and air in the facility. LPA observed there were food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times. LPA observed the backyard area in good condition containing old wheel chairs and trash stored in corner of backyard. LPA gave technical assistance in regards to trash in the backyard. Licensee stated, trash pick up day will be scheduled for next week. Licensee will show proof of scheduled pick up date on 11-5-21. LPA notified Licensee that the trash needs to be taken care by 11-11-21 with follow up email showing proof the trash is gone from both locations of the facility. Mitigation Plan was submitted and approved. Upon a file review the following items were discussed to be submitted with any changes annually: Criminal Record Clearances LIC508 Administrative Organization LIC309 Designation of Administrative Responsibility LIC308 Personnel Report LIC500 Qualifications of Administrator/Facility Manager- Administrator certificate Emergency Disaster Plan LIC610D Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, there were deficiencies cited during this visit. Exit interview held and a copy of report was provided in email for signature from licensee and copies faxed and emailed back.