Routine inspection·May 14, 2021

On 05/14/2021 at 12:10pm, Licensing Program Analyst (LPA) T. White spoke with Administrator, Arlyn De La Cruz regarding facility risk assessment questions. Administrator confirmed no staff or clients have experienced symptoms within the last 10 days. At 12:15pm, LPA T. White arrived unannounced to conduct a required 1-year annual inspection. LPA met with Administrator and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 6 residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. A comfortable temperature is maintained at 75 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during inspection. Fire extinguisher was last serviced on December 10, 2020. First aid kit was observed to be complete. LPA reviewed mitigation plan with Administrator. - LPA observed three screw drivers and 5 screws in unlocked kitchen drawer. - LPA observed knobs missing on kitchen stove. - LPA observed unlocked cleaning solution located in 2 of 4 resident rooms. - LPA observed scissors located in resident's room accessible to residents in care. - LPA observed a hammer in the backyard accessible to residents. - LPA observed unlocked tools in the garage accessible to residents in care. - LPA observed ramp is a potential hazard to residents in care. LPA observed ramp had missing wood which could be a tripping hazard. Report continues on 809C. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 05/28/2021: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. LPA had printer issues and will submit report and appeal rights via email. Exit interview conducted with Administrator.