Routine inspection·October 27, 2021

On 10/27/2021 Licensing Program Analyst (LPA) Ashley Boothe arrived unannounced to conduct a Required 1-year Annual Inspection at 4:15pm with Licensee Edgar Espiritu. Administrator Ruth Banaga arrived shortly after. LPA was allowed entry into the facility that is licensed to serve a total capacity of 15 and today's census is 15. Licensee accompanied LPA on facility tour. Five of five staff observed on site with criminal record clearance in Licensing Information System. LPA observed Administrator Certificate expires on 8/29/2022 and Licensee's Certificate expires on 3/20/2023. LPA interacted with a random number of residents during this visit and observed clients. The physical plant was toured inside and outside to ensure the safety of the clients. LPA observed kitchen, restrooms, bedrooms, and common living areas. LPA observed items not in use or good repair stored in backyard. LPA observed toxins, knives, centrally store medications stored inaccessible to residents. The temperature inside the facility was measured at 74*F which is within the required range of 68*F and 85*F, or in areas of extreme heat the maximum shall be 30*F less than the outside temperature. The hot water was measured at 107*F within regulatory range of is not less than 105*F and not more than 120*F. The first aid kit was found in compliance containing at least the following: a current edition of an approved first aid manual, but containing sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and antiseptic solution. LPA observed COVID precautions signs posted, restrooms stocked with paper towels, hand soap, touchless covered trash cans, and posted hand washing signs. 30 day supply of PPE stored on site. Stsff one (S1) stated common surfaces are disinfected daily and in between use. LPA observed hand sanitizer available throughout the facility. Observed MAR system in use but weekends in October not signed by facility staff, not documented when staff two (S2) was scheduled off. S2 stated medications are given but not signed off on MAR because other staff administer them but they do not write it down. LPA observed fire extinguisher last inspected on 7/19/2021, fire suppression system last inspected on 3/2020. Observed smoke and carbon monoxide detectors, central heating and air in the facility. LPA observed food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times. The facility last conducted fire drill on 6/20/2021. Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Administrative Responsibility LIC308 Personnel Report LIC500 Administrator Certificate Emergency Disaster Plan LIC610E Liability Insurance Health Screening Report-Facility Personnel LIC503 First Aid/ CPR certificates Per California Code of Regulations (CCRs) - Title 22, Division 6, the following deficiencies are being cited on the attached 809D during this visit. Civil penalties shall be assessed when the licensee fails to correct the violation and any appropriate extensions to the plan of correction due date. The Licensee was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. Exit interview held and a copy of report was given.