Routine inspection·July 22, 2024

On 7/22/24 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility for the purpose of conducting a 1 year required visit. LPA met with Caregiver Mary Rose Delos Santos and explained the purpose of the visit. At the time of the visit there were (2) staff and (6) residents present. The facility is licensed to serve 6 non ambulatory senior residents. The facility has an approved hospice waiver for (2). There are currently (0) residents receiving hospice services. LPA was informed that the facility will be undergoing a change of ownership. The facility administrator was unavailable during LPAs visit to verify the status. LPA toured the facility interior and exterior of the facility. LPA observed the facility to be clean and in good repair. The facility is maintained at a cool and comfortable temperature. There are no known guns or ammunition, or pools or bodies of water on the premises. All outdoor and indoor passageways are free of obstruction. Food prep and storage areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. The medications are centrally stored medication in a locked closet by the dining area. The facility has seven (7) dual fire and carbon monoxide detectors, 1 central alarm for the outside, they were tested and observed to be operable. The facility was observed to have the required postings. However there was no proof of liability insurance available for LPAto review. Deficiency cited. LPA conducted a review of (3) resident and (3) staff records/files. LPA observed for the files to have the required documentation such as a medical assessment, appraisal, and admission agreement. Regarding the staff files all staff present were observed to have obtained criminal record clearance and to be associated to the facility. The administrator Bella Margate does possess a valid administrator certificate. LPA observed Staff # 1, Staff #2 and Staff # 3 to all have expired Cardio Pulmonary Resuscitation (CPR). Deficiency cited. In addition LPA conducted a facility file review prior to conducting the visit and observed for the facility to have not paid their annual fees that were due on or before 07/01/24. As of today 7/22/24 the current amount due is $742.00. Deficiency cited. A review of the facilities emergency disaster drills that the facility is not conducting the drills on a quarterly basis, as the last documented drill is noted to have occurred on 6/3/23. Deficiency cited. Based on today's inspection deficiencies were cited on the attached 809D, in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted where a copy of this report, appeal rights, LIC9098-Proof of Corrections form, and LIC 811-Confidential names list was provided to Maryrose Delos Santos.