Routine inspection·February 18, 2025

LPA Audrey Jeung toured facility and grounds, including detached storage building. There are 3 shared client bedrooms--only 2 are occupied as private rooms--a staff room, 2 full bathrooms, living/dining room, TV room, and kitchen. Washer and dryer are located in 1-car garage. There are no accessible bodies of water or fire safety hazards observed. Carbon monoxide detector is tested and operable. Hot water temperature is tested at 116 degrees in rear client bathroom. Medications and sharps are stored appropriately and inaccessible to clients, a comfortable room temperature is maintained, and lighting is sufficient for safety. First-aid kit is maintained and complete. Client files are reviewed, including Centrally Stored Medications Records. A Disaster and Mass Casualty Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff training records. Ane Haupeakui and Tomasi Haupeakui oversee facility operations; Tomasi's RCFE administrator certificate expires 2/25. As per legislation, effective 1/1/2015, the following information is posted: 1) text of Health and Safety Code 1569.269 AND CCR Title 22 Section 87468 (Personal Rights form LIC613C), per AB2171; 2) CCLD Hotline information, per SB895. The following licensing forms are requested to be completed and submitted to CCLD BY 2/25/25: - Designation of Administrative Responsibility (LIC308) - Personnel Report (LIC500) - Emergency Disaster Plan (revised 9 page LIC610-E signed and dated on page 9) - Facility Sketch (LIC999), including dimensions - Proof of current liability insurance Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. Also, see Technical Advisory Note. Facility is not in compliance with Section 87470 Infection Control Plan: An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. (1) The Infection Control Plan shall include all of the following: (A) Identification of a staff position to perform the duties of an Infection Control Lead for the facility. 1. Contact information for the designated Infection Control Lead shall be made available to the department upon request. 2. A description shall be included of how the Infection Control Lead shall be trained by a medical professional, local health official, health department, or other research-based medical authority that provides infection control training that will include enforcement of the Infection Control Plan. (B) A description of how the licensee shall meet the specific infection control practice requirements of subsections (a), (b) and (d). (C) An Infection Control Training Plan. 1. Initial training requirements for new facility staff shall be addressed in the plan, with training to be provided by the Infection Control Lead before staff works independently with residents. 2. Ongoing training requirements for all facility staff shall be addressed by the plan, with training to be provided by the Infection Control Lead. 3. The description of initial and ongoing training shall address the requirements of subsections (a), (b) and (d). (D) The licensee shall review the use of infection control procedures in the facility at least annually, if local government public health determines an epidemic outbreak has occurred, or if the review is requested by the local licensing agency. (E) The licensee shall ensure that staff encourage residents to follow infection control practices as necessary.