Routine inspection·March 28, 2022

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required – 1 Year inspection on 3/28/21 at 10:00am. LPA met with Rangi Giner, Administrator and Junelle Pangilinan, medication Technician and Beatrice Diwata, Medication Technician and stated the purpose of today’s visit. LPA w as allowed entry into the facility that is licensed to serve a total capacity of 34 bedridden clients. The Administrator Certificate expires on 11/19/2022 for Junelle Pangilinan. The facility has an approved hospice waiver for 10 and there is 1 resident using hospice services at this time. LPA interacted with a random number of residents during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. LPA observed residents participating in group activities using social distancing during this visit. LPA observed the kitchen area, dining area, bedrooms, bathroom, storage areas, and laundry room, knives to be locked, required furniture, and lighting throughout the facility. LPA observed large storage containers outside holding personal care products and decorations to be locked. The temperature inside the facility was measured on the wall thermostat at 70*F which is within the required 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 127.8*F which is not less than 105 degrees F (40.5 degrees C) and more than 120 degrees F (48.8 degrees C) as per Title 22 regulations. LPA observed hot water temperature to be too high in the bathroom and 2 resident rooms which will be cited during this visit. LPA observed the centrally stored medications area to be locked and inaccessible to clients. 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. Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Administrative Responsibility LIC308, Liability Insurance, Personnel Report LIC500, Qualifications of Administrator/Facility Manager-Certificate Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 809D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Staff was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, and a copy of the report was given.