Routine inspection·September 25, 2024

On 09/25/2024, Licensing Program Analyst (LPA) Vado Jaime Vado conducted an unannounced annual required 1 year inspection visit. LPA met with caregiver Jeremiah Slavador and explained the purpose of today's visit. There are 2 staff present and 4 residents in the facility. According to staff there are 3 GGRC residents and 1 RCFE resident. Around 245pm the licensee met with LPA Vado at the facility. This is a single level facility licensed for residents age range of 60 years and over all of which may be non-ambulatory and one bedridden. License is approved for 3 hospice residents. There are no residents on hospice as of this visit. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. There are no video cameras on site per the caregiver. LPA observed the facility kitchen which is observed as in good working condition. Knives are stored and locked in a drawer adjacent to the sink. There is a locked cabinet beneath the kitchen sink but no cleaning supplies are present when observed. Perishable and non-perishable food supplies are observed as in place. There is an additional cabinet in the garage which stores additional canned goods and dry goods for resident and staff use. First aid kit is observed as complete with required items stored in the medication cabinet which is observed to be locked. LPA observed at least two fire extinguishers in place which are currently within operating range, combination smoke/carbon monoxide detectors are observed in place through out the facility, and central heating. A carbon monoxide detector in place located in a hallway was tested but it did not work. The facility had combination carbon monoxide/smoke detectors in place that did work. PPE is observed to be in place. Emergency exit routes are observed inside and outside to be free and clear of obstructions. LPA made observations of the exterior and observed items stored beneath the raised wooden walkway such as old bed frames, screen doors, a shopping cart, and old wheel chairs. Additionally LPA observed unlocked paint cans stored beneath the walkway. The paint cans pose an immediate health and safety risk to residents in care. Water temperature was measured in a resident bathroom at 122F and increasing during testing which poses as a health and safety issue for residents in care. In this same bathroom LPA observed cleaning solutions stored beneath the bathroom sink which poses an immediate health and safety risk to residents in care. Cleaning supplies are observed to be locked in the garage primarily. Continued on next... Page 2 LPA did observe several items as not in good repair during the inspection such as: torn or missing window screens on resident windows, broken carbon monoxide detector did not function when tested in the hallway central to resident room towards the front of the facility, and a broken grab bar that is under repair per staff interview which can poses as a health and safety risk to residents in care. LPA observed all resident rooms as clean, free of odors, and contained all the required furniture per regulatory recommendations. Linen closet is observed as stocked with such items for resident use. Shower floors are equipped with non-skid mats or flooring as observed. Facility does not handle resident monies. Medications and logs are observed today as current. During today's inspection LPA reviewed four resident files and three staff files. Administrator certificate is expired as of 07/06/2024 but according to the administrator/licensee she has already renewed and is pending per administrator certification branch. The following updated forms are requested to be submitted to CCLD by 09/30/2024 : • Copy of administrator certificate • Copy of facility's liability insurance • LIC308 Designation of responsible staff person • LIC400 Affidavit regarding client/resident cash resources • LIC402 Surety bond information with expiration date • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule • Copy of control of property or copy of lease Citations are issued on this day on the attached LIC809D pages. Report is reviewed with licensee Karin Lastimosa and a copy is provided.