Routine inspection·January 25, 2023

Unannounced annual visit made out to this facility on 01/25/2023 by Licensing Program Analysts (LPAs) Charlie Yang and Kimberly Viarella who were met by the facility caregivers, JoeRey Pastrana and Olivia Camanag. LPA Charlie Yang requested that the facility caregiver go ahead and contact the facility designated Administrator, Joyce Mae Mabunga, to inform her that CCL was present at this time. The facility designated Administrator, Joyce Mae Mabunga, arrived later to this facility while the LPAs were conducting this annual visit. Brief interview was conducted with the facility designated Administrator. Current census was (5) residents of which (2) are under the care of home health and (2) residents are under the care of hospice at this time. This facility does have an approved hospice waiver to accept and retain up to (2) hospice residents at any given time. Tour of the facility was conducted. Living area, dining area, and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. Kitchen area was toured. Cabinets and drawers were reviewed. Knives and other sharp objects were observed to be locked and made inaccessible to the residents at this time. Food supply was reviewed to make sure that there was a sufficient amount of 2-day perishable and 7-day nonperishable quantities at all times. Medication cabinet, located in the kitchen area, was reviewed. Policies and procedures for handling, dispensing, and documentation of the resident medications was discussed with the facility designated Administrator. Dispensing log was also reviewed along with the Medication Administration Record. A tour of the resident bedrooms was conducted. Furnishings and furniture were observed to be sufficient and maintained in compliance at this time. A tour of the resident restrooms was conducted. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees at all times. Grab bars and non skid mats were observed to be present and in good repair at this time. A tour of laundry room was conducted. It was observed to be locked and made inaccessible to the residents at this time. Laundry detergent, bleach, and other cleaning agents were observed to be present as well. A tour of the garage area was conducted. Additional supplies and items were present for resident use. Linen closet, located in the dining area, was observed to be stocked with adequate towels, comforters, and sheets sufficient to meet the needs of the residents at this time. First aid kit was observed to be present and contained all of the necessary components at this time. Fire extinguishers (2), were located in the entry way and exterior patio area, and were observed to have been annually inspected on 09/27/2022 by the local fire extinguisher company, Armor Fire Extinguisher Company, and in compliance at this time. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gate, and all exits was conducted. It was observed that this facility has an exterior shed in the backyard area. A review of the shed was conducted and observed to be locked and made inaccessible to the residents at this time. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Code. The appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interview