Routine inspection·December 6, 2023

Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Cecilia Earnest and was granted entry to the facility. The facility is a (3) bedroom (2) bathroom home and, with a kitchen/dining area, living room, garage. Licensed capacity is (6) current census (6). LPA was accompanied by Cecilia Earnest to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The hot water temperature tested within regulation at 112 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps were locked. There was a designated space for client/staff files. During tour, the facility did not remain free odors from incontinence. In addition, LPA observed a couch blocking refrigerator and kitchen area, which is a repeated violation from April 4,2023. LPA observed a lock on food cabin. Facility did not have at least on internet device dedicated for residents. During observation and interview facility did not have all the following information readily available during an emergency for staff. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a variety of food available for clients. Dishes, cups, and utensils were also stored properly. Care & Supervision: Administrator confirmed to LPA the facility did not have a designated substitute on premises. The licensee informed LPA the Administrator and facility manager are the same person. Facility did not have designated substitute to operate the facility when Administrator is temporarily absent. Record Review: LPA reviewed (6) resident files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed (3) staff files. 1 out of the 3 staff did not have CPR, dementia training. During today’s visit facility did not have a staff on premises with CPR certificate. S1 confirmed they did not have a CPR certificate and have not received training. S1 was the only staff on premises during visit. In addition, facility did not have Plan of Operation on file in the facility. LPA did not observe planned activities. S1 stated facility did not have planned activities for the residents. Facility did not have a current edition first aid manual. LPA discovered facility was not conducting a drill at least quarterly for each shift. During medication audit, LPA reviewed 3 out of 6 residents’ medication. LPA discovered the facility did not have date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. LPA observed medication was transfer to another container. Based on the observations made during today’s visit, (6) Type A and (7) Type B deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. And (1) Civil Penalty in the amount of 1,000 will be issued for repeated violation. An exit interview was conducted, and this report (LIC809) (LIC809) was discussed and provide to Care Giver Cecilia Earnest. Along with appeal right.