Routine inspection·December 4, 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 care giver Jane Perias and was granted entry to the facility. The facility is a (6) bedroom, (2 and 1 /2), bathroom home and, with a kitchen/dining area, living room and attach garage. Licensed capacity is (6) current census (6). LPA was accompanied by care giver Jane Perias 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). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, nightstands, 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 122 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, and other dangerous items were kept inaccessible to clients in care. All sharps are locked. There was a designated space for client/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care. 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: Facility does not have sufficient care staff for coverage 24 hours a day, 7 days a week. LPA observed one staff working at the facility. S1 and Administrator informed LPA that the facility has one staff work per shift. Facility has (4) four residents in hospice and (4) four residents with dementia. Record Review: LPA reviewed (6) client files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed (6) client medications. LPA also reviewed (63) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA did not observe planned activities for residents. Based on the observations made during today’s visit, two (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809)(LIC809D) was discussed and provided to Administrator Abigial Tamisin. Along with appeal rights.