Routine inspection·October 24, 2024

On 10/24/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Caregiver, Jude Torres. Licensee/Administrator, Maribel Cayco was contacted and informed of the visit but unable to attend due to being out of the country. The facility currently provides care for 5 residents, none of which are receiving hospice services and some of which with a diagnosis of dementia. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located in kitchen and garage were found to be charged. Smoke and carbon monoxide detectors located throughout the facility were in working order. There was a sufficient supply of both perishable and nonperishable foods as required, with food stored in the kitchen, sufficient for residents in care. Food supply is replenished constantly throughout the week and stored properly. Facility provides a wide variety of meal preferences and preparation while also ensuring proper dietary restrictions are followed. Sharps stored under the kitchen sink and cleaning supplies stored in the bathroom were found to be secured. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items.There is a single outdoor patio for resident use with shading. Exits are also equipped with motion sensors with auditory alarms signaling to the staff common area. Continued onto LIC809-C LPA conducted a sample file review for residents and found that one (1) resident (R1) with a primary diagnosis of dementia is in need of an updated physician's report. In addition, a technical violation was issued for a resident (R2) that was newly admitted on 9/3/2024, in need of a full medical assessment prior to admission. Upon a spot check of staff files, LPA found that caregiver staff have current 1st aid and CPR and onboard records on file. Lastly, A spot check of medications was conducted and found that all medication counts and records to be in order. Maribel Cayco's Administrator Certificate, 7011093740 is currently on the department pending list for renewal as of 7/17/2024. LPA requested the following documents be sent to CCL by COB 11/7/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan Liability Insurance Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties