Routine inspection·January 5, 2024

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Apolinario Perez, Licensee , and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (6) and a current census of (4) residents in care. The facility has a hospice waiver for (3) residents. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant: Indoor and outdoor passageways are free of obstruction. The facility has no bodies of water accessible to residents in care. The facility is maintained at a comfortable temperature and has sufficient lighting, and indoor space for resident activities. The facility backyard is fenced and sufficient for resident activities. Resident’s bathrooms were operating in safe and sanitary conditions. The hot water temperature in residents' bathrooms measured between 106- and 111-degrees F. Resident’s bedrooms have sufficient lighting and furniture in good repair. Facility has operating carbon monoxide alarms and telephone service. The facility has sufficient linen, towels, and personal hygiene items for residents. The facility has posted in a common area, Community Care Licensing complaint poster, Ombudsman poster, resident's personal rights, disaster evacuation plan and emergency telephone numbers. Food Service: Facility has sufficient non-perishable and perishable food supply for residents in care. The refrigerator and freezer are operating in a healthful manner. Sharps, pesticides and other cleaning solutions were kept locked and stored away from food areas. Care & Supervision : Facility has 24-hour, 7 days a week care support staff. Record Review: Licensees' Administrator’s certification expires on 3/17/2024. (4) staff files were reviewed. Staff record review reveals, the facility did not maintain records of First Aid/CPR training and completed health screening for staff #1 (S1) and staff #2 (S2). Resident record reviews reveals, the facility did not maintain completed preplacement appraisals for resident #1 (R1) and resident #2 (R2). Medical Related Services : Facility has complete First Aid kits with manual. All medication is centrally stored and kept in a locked cabinet. Based on LPA observations and record review, deficiencies are being cited per Title 22, Division 6 of The California Code of Regulations. An exit interview was conducted where reports LIC809, LIC809-C, LIC809D, and LIC9102 were discussed. Copies of the reports with Appeal Rights were provided to the Licensee at the conclusion of the visit.