Routine inspection·November 13, 2023

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by caregiver Chioma Alozie. LPA discussed the purpose of the visit with caregiver Alozie. Licensee Edward Alozie 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 of which 1 may be bedridden and the facility has a waiver for two (2) hospice residents at the facility at any given time. During today’s inspection, the facility’s current census is 6 residents living at the facility. There were 6 residents present at the facility site during the inspection. LPA, accompanied by caregiver Bridget Alozie, toured the interior and exterior 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 75 degrees Fahrenheit (F). Hot water temperature at taps accessible to residents were also compliant: Kitchen sink was 123.4 degrees F; sink in restroom #1 delivered hot water at 120.4 degrees F; sink in restroom #2 delivered hot water at 120.7 degrees F; and sink in restroom #3 delivered hot water at 125 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 all safely stored. There were no toxic chemicals/poisons accessible to residents. Medications were properly labeled, as required, and stored in locked areas. LPA inspected the medication room and found that medications were properly labeled and stored in a locked cabinet. The facility maintained medication logs which LPA reviewed. [CONTINUED ON LIC 809-C] No pools or bodies of water on the premises. Per licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers were present (02) and serviced within the last 12 months. First aid kits were complete and readily accessible. LPA reviewed staff and resident records. LPA records review and facility inspection did not raise any licensing concerns. The files which LPA reviewed contained relevant documents. Confidential records were stored in a locked drawer. Required licensing postings were observed in a visible area of the facility. There was a deficiency observed and cited during today's annual inspection and can be found on the deficiency page along with technical advisories. A plan of correction was jointly developed with the Licensee. An exit interview was conducted with Licensee Edward Alozie 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 Licensee Alozie 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 .