Routine inspection·March 14, 2024

On 3/14/24, Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with licensee, Juliet See and introduced self and stated purpose of the visit. LPA was informed that there are currently 3 residents home. The facility has 3 bedrooms, 2 bathrooms, kitchen, dining area, living room, family room, attached garage, and backyard. LPA completed a walk through of facility, review of records and medication audit. 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 of 71 degrees fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. LPA observed that the master bedroom that is occupied by two residents is used as a passageway to the bathroom for all residents . Deficiency issued. Water temperature tested at 113.6 degrees fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, fire extinguisher and first aid kit. Posters such as; the personal rights, ombudsman and emergency disaster plans were posted in a common area. LPA observed cleaning supplies, chemicals and staff medication made accessible to residents. Deficiency issued. There was a designated storage space for resident/staff files. LPA observed the filing cabinet with resident records was unlocked. Technical violation issued. Resident medications were observed secured and inaccessible to residents. There is no swimming pool, bodies of water, guns or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service : Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a wide variety of food available for residents. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, a side gate with self-latching handle on the left and right side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed 2 resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed incomplete documents, missing signatures, and initials on the records reviewed. Deficiency issued. LPA also reviewed 2 staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed that the staff present in the facility had an expired first aid/CPR certification. Deficiency issued. LPA observed that the licensee did not request and submit a criminal background clearance for her son. Deficiency issued. Medications were audited at random and appeared to be dispensed appropriately by staff. Emergency Disaster Drill was last conducted on 1/8/24. LPA observed the Emergency Disaster Plan last reviewed on 04/09/23. Deficiencies and one technical violation were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102TV and appeal rights were discussed and copies were provided to licensee, Juliet See.