Routine inspection·June 12, 2024

On June 12, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 9:30 AM to conduct the unnanounced Annual 1-year required inspection. LPA Calandra was greeted by Michelle Perez, Caregiver and explained the purpose of the visit. Arlene Gomez, Administrator was contacted by phone but could not join the visit. LPA Calandra toured the physical plant. This is a 1-story building which consists of 7 bedrooms, two bathrooms, a backyard, a staff bedroom, and storage room. All bedrooms had the required furniture and sufficient lighting. All bathrooms had the required grab bars and non-skid floor mats. No accessible bodies of water or hazards were observed. The facility temperature was set to 70 degrees Fahrenheit. The facility had the required 7 days of non-perishables and 2 days of perishables on site. No food was expired. The fire extinguishers were observed to be fully charged and last inspected by the fire department on January 11, 2023. At 1:00 PM, Michelle Perez, Caretaker showed LPA Calandra the 2024 fire extinguishers which were observed to also be fully charged. The facility's first aid kit was observed to have the required sterile first aid dressings, bandages, scissors, tweezers, and thermometers. The facility's smoke and carbon monoxide detectors were observed to be in working order.Per a conversation with Jay Navarez on the phone at 10:24 AM, the smoke and carbon monoxide detectors are connected directly to the San Francisco Fire Department. All sharp objects, poisons, soaps, and detergents were observed to be locked and in-accessible to persons in care. LPA Calandra reviewed 5 resident files and 5 staff files. Resident files were observed to have incomplete documents such as the LIC 602: Physician's report and Annual Needs and Services Plan. Staff files were observed to have incomplete LIC 503: Health Screening Reports and TB results. LPA Calandra interviewed 4 residents and 3 staff. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication Records(CSMR) kept at the facility. A Type A violation was provided for not having TB results for S1, S2, and S3. A Type A violation was provided for not conducting emergency drills quarterly per shift and documenting those drills. A Type B violation was provided for not fixing the ceiling in Bedroom 7 which per an interview had retained water damage from the latest storms. A Type B violation was provided for not having a medical assessment for R1. A Type B violation was provided for not having Annual Needs and Services Plans for R1, R2, R3, R4, and R5. LPA Calandra requested the following documents be sent to the Regional Office: -Updated LIC 500 -Current Lease Agreement -Administrator Certificate The Annual inspection will be completed at a later date. Deficiencies are cited under California Code of Regulations, Title 22, cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report was reviewed with Michelle Perez, Caregiver and an exit interview conducted. A copy of the report along with appeal rights were left at the facility.