Routine inspection·October 19, 2023

On October 19, 2023 Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA was greeted by caregivers, Luisa Dizon and Maria Burgos and LPA explained the purpose of today's visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed 2-day perishables and 7-day non-perishables, Facility has 5 resident bedrooms (4 private rooms and 1 shared room), 1 staff room, 2 full- bathrooms, kitchen, and common areas. The facility observed to clean, tidy and in good repair. Bedrooms were equipped with the required furniture for residents to use. Bathrooms are equipped with grab bars, and nonskid mats. Facility temperature is comfortable. Hot water temperature was measured at 108- 112 degrees F. The most recent emergency drill was conducted on June 24, 2023. Fire extinguisher(s), smoke and carbon monoxide detectors in the facility. Central stored medication, toxins and sharps objects were locked and inaccessible to residents. Staff training records were reviewed to be adequate. LPA reviewed 6 resident files and all of them contained medical assessment, and GGRC/IPP. However, 3 out of 3 resident's file did not contain a facility Admission Agreement, and 4 out of 6 residents did not have an Appraisal Needs and Service Plan. This observation was presented to the caregivers. LPA reviewed 3 staff files that contained personnel records, health screening, Job Description, Abuse Statement, First Aide and CPR, Criminal Record Statement. During today's inspection, there are 4 residents present and 2 were attending the adult day program. LPA requested for a copy of the Liability Insurance, and Control of Property to be submitted to CCL by 10/20/2023 Based on observation, deficiency is cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with caregivers. A copy of this report and Appeal Rights were provided.