Routine inspection·February 20, 2024

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility background information was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by caregiver Lorena Banuelos Castillo. LPA discussed the purpose of the visit with caregiver Blanca Garcia. Facility Manager Elda Acosta later arrived and joined the visit. According to the facility’s license, there may be a maximum of six (6) residents all of whom may be non-ambulatory in at any given time at the facility site. They may have one (1) bedridden resident in bedroom #2 and the facility is approved for a hospice waiver for 1 resident. During today’s inspection, the facility’s current census is 4 residents living at the facility. There were 4 residents present at the facility site during the inspection. LPA, accompanied by caregiver Garcia and facility manager Acosta, toured the interior and exterior sections of the facility, and inspected each room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 76 degrees Fahrenheit (F). Hot water temperature at taps accessible to clients were also compliant: kitchen sink delivered hot water at 120 degrees F; sink in restroom #1 delivered hot water at 105.1 degrees F; and sink in restroom #2 delivered hot water at 105.1 degrees F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present and stored. Sharps were not safely stored in a locked or inaccessible area but facility manager placed a lock on the cabinet door during the inspection. There were no toxic chemicals or poisons accessible to residents. LPA found that medications were properly labeled, as required, and stored in a locked area. The facility maintained medication logs which LPA reviewed. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] No pools or bodies of water on the facility premises. Per facility manager Elda Acosta, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present (01) and serviced within the last 12 months. First aid kit(s) were readily accessible. LPA interviewed staff and residents, and reviewed staff and resident records. During today’s visit there were 4 residents on the facility premise. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility. There were deficiencies observed and cited during today's annual inspection and may be found on the LIC809-D page of this report along with the Technical Advisory's. An exit interview was conducted with facility manager Elda Acosta to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received. LPA requested facility manager Acosta to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, Emergency Disaster Plan LIC 610-E, and Residential Infection Control Plan LIC 9282 (6/23), to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov .