Routine inspection·July 26, 2023

Licensing Program Analyst (LPA) Cheryl Goodrich conducted an unannounced annual visit. LPA met with the Caregiver Nestor Blay at the front door and was granted entry. The purpose of today’s visit is to inspect the facility to ensure that the facility follows California Code of Regulations, Title 22, Division 6. Facility is approved for five (5) ambulatory and non-ambulatory residents. Physical Plant: front entrance, interior and surrounding exterior were clean and in good repair with no pathway obstruction; doorway alarms were in working order; residents' main restroom water temperature read at 119.1 degrees; there were no bodies of water on premises; there was sufficient lighting and mattress pads in all of the residents' bedrooms; fire alarm and smoke carbon monoxide detectors were in working order. Facility does not house firearms and/or ammunition on grounds. Food Services : 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available to residents. No emergency food supply was observed. Medication/Facility Records: Medications were observed to be labeled and in a locked place that is inaccessible to residents. All staff subject to a criminal record review obtained fingerprint clearance and/or an exemption. (Continued on LIC809-C) (Continued from LIC809) Licensee has completed a written admission agreement and needs and service plan with each resident. Waivers are in place and meet said terms. Licensee handles no resident cash resources. Administrator Certificate is current and will expire on November 2024 Items Discussed: Knives were left in kitchen drawer accessible to residents. Both staff are not CPR/First Aid certified. The staff is not documenting the date or time PRN medications are administered to the residents which is evidenced by review of resident record. The staff (S1) is communicating with the physician’s regarding PRN medications however does not document the contact with the physicians responsible for prescribing the medication. The staff are not providing activities to the residents. The Administrator has not conducted any fire drills since 2022. The Administrator does not have a resident roster for the facility. LPA Goodrich was informed by residents R1 that S2 ignores her requests for items and assistance and only “does it when he feels like it”. Resident (R1) states she is not treated well by that staff member and they got into an argument prior to my arrival. Staff (S2) was observed fixing coffee for R4, and R4 continued to ask to ask S2 for coffee, but none was provided until much later. Summary : Based on today's visit, deficiencies were observed, and the facility has been cited. An exit interview was conducted with staff Nestor Blay and a copy of this report was printed Signature below confirms receipt of these rights and appeal rights given.