Routine inspection·April 10, 2025

On 4/10/2025 a unannounced annual visit made at this facility by Licensing Program Analyst (LPA) Holly Williams and Licensing Program Manager (LPM) Czarrina Camilon-Lee.  This LPA and LPM was met by the Facility Designated Administrators (FDA) Dessislava Dimitrova's mother S1 and father S2. The FDA Dessislava Dimitrova came to the facility and a brief interview was held with Dimitrova. Current census was 2 residents. It was learned that there were (0) residents under the care of hospice at this time. It was learned that there was (0) resident receiving services through home health at this time. It was learned that there were (1) residents diagnosed with dementia at this time. Facility staff files were supplied by the Licensee for review at this time.  This LPA also requested for the facility resident files at this time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured.  Furniture [Continued on 809-C] and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. LPA observed grime, grease, and a sticky floor through out the kitchen. LPA observed in the drawers in the kitchen an excess amount of napkins, plastic, and the drawers had not been cleaned. Based on facility sketch room #3 designated as a client room has been changed to a staff room. Similarly, the master bedroom approved for resident room has been changed to a staff room. LPA advised the FDA to correct facility sketch and obtain new fire clearance. Facility resident bedrooms were toured.  LPA observed in R1's room unlocked medications and it states in the LIC 602 that the resident is not allowed to handle their own medication. Facility resident restrooms were toured. Grab bars and non-skid mats in bathroom were observed to be present and in good repair at this time. Kitchen drawers and cabinets were opened and reviewed.  Knives were observed to be unlocked in the kitchen drawers. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed and were adequate. Food in the refrigerator was not covered. Laundry area, located in the walkway leading to the outside, was toured.  Bleach, detergent, and all other cleaning supplies were observed to be unlocked and accessible to the residents. Medication cabinet, was observed to be unlocked and accessible to the residents. First aid kit, located in the medication area, was reviewed and requested the items to be provided including a manual and scissors. Fire extinguishers (2), located throughout this facility, were observed to have been annually inspected by the local fire extinguisher company Jorgensen, and found to be in compliance at this time. LPA observed bedroom 2 and the staff room did not have smoke detectors. LPA advised the administrator that the 2 smoke detectors need to be replaced because they are missing. Overall the LPA observed the facility needs a major deep cleaning to include; floor surfaces need to be washed, carpet needs to be replaced, walls, cabinets, windows, and baseboards need to be wiped down. [Continued on 809-C] Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted.  A review of the facility perimeter fence, side gates, and all other exits was conducted.  LPA observed tools, rakes, and ladders that were accessible to resident's. A review of (2) facility resident files was conducted and noted on the following LIC 858. A review of (2) facility staff file was conducted and noted on the following LIC 859. The following forms and documents were requested to be updated and submitted to CCL: LIC 500 LIC 308 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interview