Routine inspection·October 17, 2024

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 resident Elaine Meaole. LPA discussed the purpose of the visit with Assistant Manager Bridget Alozie and Licensee Edward Alozie who 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 in at any given time at the facility site. Facility is approved for two (2) hospice residents. 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 Licensee 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. The facility had ample Personal Protective Equipment as a part of their infection control protocols. 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 72 degrees Fahrenheit (F). Hot water temperature at taps accessible to residents were also compliant: kitchen sink measured hot water at 115.3 degrees F; sink in staff restroom #1 delivered hot water at 120 degrees F; sink in restroom #2 delivered hot water at 114.6 degrees F; sink in restroom #3 delivered hot water at 116.8 degrees F; and back room sink delivered hot water at 107 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 or poisons accessible to residents. Medications were properly labeled, as required, and stored in a locked cabinet. LPA inspected the medication area and found that medications were properly labeled and stored. 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 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 (03) and serviced within the last 12 months. First aid kit was complete and readily accessible. LPA interviewed residents, and reviewed staff and resident records. During today’s visit there were 6 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. 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, Residential Infection Control Plan [LIC 9282 (6/23)], and current copy Certificate of Liability Insurance to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov .