Routine inspection·December 6, 2023

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Adelaida Galasinao , Administrator, 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 (5) residents in care. The facility has a hospice waiver for (2) 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. Outdoor shaded area is sufficient for resident activities and enclosed by self-latching gates. The facility has sufficient lighting and is maintained at a comfortable temperature. Resident’s bathrooms were operating in safe and sanitary conditions. The hot water temperature in residents' bathrooms measured 105 to 108 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, facility license, Community Care Licensing complaint poster, Ombudsman poster, 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. 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 staff. Staff working have criminal record clearances or exemptions through the Department. Record Review: (3) staff files reviewed were observed to be complete. (1) out of (3) resident files were observed to be complete. Facility did not maintain a completed physician's report or medical assessment, including tuberculosis results for resident #1 (R1) on file. Facility did not maintain a preplacement appraisal for (R1) on file. Facility did not maintain a completed physician's report or medical assessment for resident #2 (R2), report did not include physician's signature and date. Medical Related Services : 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-D/LIC9102) were discussed with the Administrator. Copies of the reports with Appeal Rights were provided to the Administrator at the conclusion of the visit.