Routine inspection·September 12, 2024

On September 12, 2024 Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA was greeted by caregivers, Maria Burgos and Ronaldo Marcos and LPA explained the purpose of today's visit. The administrator, Isabelle Gil arrived shortly thereafter and assisted with the 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- 119 degrees F. The emergency drills were reviewed. Central stored medication, toxins and sharps objects were locked and inaccessible to residents. Staff training records were reviewed to be adequate. Bed sheets, linens, and towels were observed to be sufficient and able to meet the needs of the residents at this time. A review of (5) resident files was conducted and noted on the LIC 858. A review of (2) staff files was conducted and noted on the LIC 859. During today's inspection, there are 3 residents present and 2 were attending the adult day program. During the tour, LPA observed a storage unit in the yard and inside the storage unit, there were 2 beds, TV, a chair, exercise equipment, and personal items such as clothing, medications, shoes, etc. Civil Penalty is being assessed today in the amount of $100 as the facility did not complete the Criminal Background Clearance Transfer Request for staff #1. LPA requested for a copy of the Liability Insurance to be submitted to CCL on 9/16/2024. 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 administrator. A copy of this report and Appeal Rights were provided.