Routine inspection·March 12, 2025

On 3/12/2025 at 1:30 PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Serrano met with Caregiver Myrna Sapigao and was granted entry to the facility. At the time of the visit there was two (2) staff present, and five (5) residents present. The administrator was out of town and the assistant administrator was not available at the time of the visit. The caregiver is the designated person. The facility is a four (4) bedrooms, two (2) bathroom home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory, two (2) hospice care waiver and 1 maybe bedridden resident and the current census is five (5) residents. LPA Serrano was accompanied by Staff 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 Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 70 degrees Fahrenheit. LPA Serrano inspected resident 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. LPA Serrano measured and observed the water temperatures in the bathroom to be at 105.2 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguishers were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, labor laws, and the disaster plan were posted in a common area. LPA observed that the facility does not have the Infection Control Plan available for review. Deficiency will be issued ***Continuation in LIC809C *** Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine cabinet with the resident’s medications locked. LPA Serrano observed first aid kit and first aid book at the facility. Food Service: Seven (7) days’ supply of Non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has sufficient number of staff to provide care and supervision to the residents in care. Also, LPA Serrano observed that the facility does not have dementia residents. Record Review: LPA Serrano reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. Medications/Medication Administration Record (MAR) were audited. LPA observed that resident #3 (R3) PRN was not properly recorded in the medication administration record (MAR). Deficiency will be issued. LPA Serrano reviewed two (2) staff and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed no issue. Based on the observations and record reviews 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, LIC809C, LIC809D forms, and Appeal Rights were discussed and provided to Caregiver Myrna Sapigao.