Routine inspection·July 27, 2023

On 07/27/23, Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with Administrator, Victor Mercado and introduced self and stated the purpose of the visit. LPA was informed that there are currently 3 residents in care who will be leaving shortly to senior program. The facility has 4 resident bedrooms, 2 resident bathrooms, 2 staff bedrooms, 1 staff bathroom, living room, kitchen, dining area, laundry room, backyard and 2 storage sheds. LPA completed a walk through of the facility and review of records. Physical Plant: The facility is maintained at a comfortable temperature of 78 degrees farenheit. 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 a trash can in resident's bathroom without a tight-fitting cover. Deficiency issued. Water temperature tested at 116.9 degrees farenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms and 3 fire extinguishers. Posters such as; the personal rights, CCL complaint poster and ombudsman were posted in a common area. LPA observed the emergency and disaster plan missing. Deficiency issued. LPA also observed an old facility license with the incorrect capacity number posted. Technical violation issued. LPA observed chemicals left unlocked underneath kitchen sink, knives and medication unlocked inside kitchen drawers. Deficiency issued. There was a designated storage space for residents/staff files. First aid kit was observed in a locked closet inaccessible to residents. There are no pools, bodies of water, firearms or ammunition. There are no obstructions to indoor and outdoor passageways. The facility is not clean, in good repair, and operating in safe conditions for residents in care. LPA observed counters with food crumbs, refrigerator with moldy liquid and stains inside, greasy stove with fan, dirty floors, and dead flies by windows. Deficiency issued. Food Service : There is a 7 day supply of non-perishable food. LPA observed that there is not a 2 day supply of perishable food for number of residents in care. Deficiency issued. Dishes, cups, and utensils were stored properly. Yards/Outside: One shaded patio, two sheds, and a side gate with self-latching handle on the right side of the house that leads into the backyard. Record Review: LPA reviewed residents files for admission agreements, updated physician reports, and needs and services plans. LPA observed a missing and incomplete record for 2 residents. Deficiency issued. LPA reviewed the Administrator's record for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed that the Administrator's CPR and First Aid certification expired on April of 2017. Deficiency issued. LPA also observed the Administrator's certificate expired on 04/10/2017. Deficiency issued. Per interview, observation and record review, Administrator stated that his mother and aunt sleep over during some weekends. Mother and aunt do not have criminal record clearance. Deficiency with civil penalty issued. One technical violation, deficiencies and civil penalties were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102TV, LIC421BG and appeal rights were discussed and copies were provided to the Administrator, Victor Mercado.