Routine inspection·March 13, 2024

On 3-13-2024 at 12:58pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Justin Jose and explained the purpose of the visit. This visit is the result of a previously attempted annual visit conducted on 2-16-24. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is a residential care facility for the elderly with a current census of 6. Facility has 4 bedrooms and 2 bathrooms for resident use Facility has a dining area off the kitchen and a formal living room. LPA also conducted the inspection using the CARE tool. Facility currently provides care for 0 ambulatory residents, 6 non ambulatory residents, 0 hospice, and 0 bedridden. The facility has an approved infection control plan in place. Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 73*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 7-28-23. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and inaccessible to residents in care. Medication storage area was observed to be locked and inaccessible to residents in care. Medications were reviewed and contained accompanying regulatory required Physician’s orders. First aid kit was observed to have adequate supplies and accessible to staff. During this inspection 5 resident files and 5 staffing files were reviewed for regulatory compliance. All files contained required contents including staff training. {Cont on 809C} All staff noted on LIC 500 contained criminal background clearances. LPA completed 2 resident interviews and 2 staff interviews. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Facility’s surety bond and liability insurance is current and update to date per regulatory requirements. Facility does not contain any bodies of water. LPA observed personal rights and complaint information posted. Facility has appropriate internet access available for resident use. LPA observed facility’s activity calendar and sufficient equipment and supplies to meet activity program needs of residents in care. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts monthly fire drills. LPA requested an updated copy of LIC 308 and LIC 500. LPA observed facility to have a designated ambulatory room occupied by non-ambulatory residents per regulatory definition. Per California Code of Regulations, Title 22, deficiencies were observed during this visit and noted on LIC 809D. In addition, an immediate civil penalty in the amount of $500 is issued due to fire clearance violation. Exit interview was held and a report was given to Administrator Justin Jose. Appeal rights provided.