Routine inspection·October 17, 2022

On 10/17/2022 at 10:15am, Licensing Program Analyst (LPA) Arielle Pascua arrived at this facility unannounced to conduct an annual infection control visit. LPA Pascua was greeted by staff member, Michael Gamboa and was asked to call the Administrator, Maybelyn Magsayo-Ugale to let her know that licensing was present at this time. Upon arrival the LPA observed a centralized screening point equipped with hand sanitizer and masks. Shortly after, LPA Pascua met with Administrator Ugale explained the purpose of the visit. The purpose of the visit is to conduct an annual infection control visit. This facility is licensed for 6 non-ambulatory residents and has a hospice waiver for 2. The administrator has an active certificate #6026752740 and expires on 09/17/2023. There were 4 other staff members present at this time, Michael Gamboa. Theresita Alvarez, Nora Casaverde, and Rosita Curilan. At 10:30am, LPA Pascua initiated a tour with Administrator Ugale. At 10:35am, LPA Pascua toured the laundry room and garage. Washer and Dryer were observed to be in good repair. A linen closet was identified in the garage and was observed to be a sufficient amount of linens for 6 residents at this time. LPA observed toxins, laundry detergent and other supplies to be in locked cabinets located in the garage and made inaccessible to the residents in care. At 10:45am, LPA Pascua toured the kitchen. LPA observed there to be a sufficient amount of 2-day perishable and 7-day non-perishable food supply. Kitchen cabinets, appliances, and sink were observed to be in good repair. LPA observed knives to be located in a closet located in the hallway next to the kitchen. A fire extinguisher located in the kitchen was observed to be serviced by a local fire company, Armor Fire Co. on 06/28/2022. At 10:50am, LPA Pascua toured the dining room and living room. Windows, blinds, and screens were in good repair. Furniture and furnishings intended for resident use were observed to be in maintained and in good repair. At 10:55am-11:10am, LPA Pascua toured 3 shared resident bedrooms. Resident furniture was observed to be sufficient to meet their needs at this time. At 11:15am, LPA toured two resident bathrooms. Hot water temperature was measured to be 112 degrees. Grab bars were observed to be stable and in good repair at this time. At 11:20am, LPA Pascua toured the live-in staff bedrooms and bathrooms. At 11:25am, LPA Pascua toured the exterior of the physical plant. Perimeter fence was observed to be stable and gates were in good repair. At 11:30-11:45 am, LPA Pascua observed a locked centralized stored medication cabinet located in the kitchen. Along with the Administrator Ugale, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components. The following forms and documents were requested to be updated and submitted into CCL -LIC 308 -LIC 400 -LIC 500 -LIC 610 Based on the observations made on this visit, an immediate civil penalty of $1000 was assessed for a violation of Section 80019(e)(2). This civil penalty was based on criminal record clearance transfer violation. The Licensee stated that S1 and S2 was working prior to obtaining her criminal record clearance transfer and has not done the paperwork prior to working at this facility. As a result of this visit, the following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Code. An exit interview was conducted. A copy of the 809, 809-C, 809-D, LIC421BG and appeal rights were printed and a copy was given to the facility designated Administrator, Maybelyn Magsayo-Ugale. The licensee was informed that a failure to correct any deficiencies by plan of correction due date(s) may result in civil penalties.