Routine inspection·October 14, 2023

Unannounced annual visit made out to this facility on 10/14/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregivers, Melody Corpuz and Orlando Lizardo, who were requested to go ahead and contact the facility designated Administrator Wilhelm Ick to inform him that CCL was present at this time. The facility designated Administrator, Wilhelm Ick, arrived shortly thereafter to this facility along with co-Administrator Moddie Andaya while this LPA was conducting this annual visit. Brief interview was conducted with the facility designated Administrator and co-Administrator at this time. Current census was 6 residents. It was learned that there weren't any residents under the care of hospice at this time. This facility was approved for a hospice waiver to be able to accept and retain up to (2) residents under hospice care at any given time. A tour of this facility was conducted. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Wilhelm Ick. The administrator certificate was due to expire on 03/22/2024 and in compliance at this time. Kitchen area was toured. Cabinets and drawers were reviewed. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in the kitchen area, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications was discussed with the facility caregiver Melody Corpuz. A tour of the resident bedrooms and restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperature was taken and measured to make sure that it was within the allowed range of 105-120 degrees. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Garage area was toured. This area also housed the washing machine and dryer for this facility's use at this time. Laundry area was toured. Cabinets storing detergents and bleach were observed to be locked and made inaccessible to the residents at this time. Fire extinguishers (2), located in facility kitchen area and entrance area, were reviewed to see if they had been annually inspected, or recently purchased, by the local fire extinguisher company at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gates, and exits was conducted. A review of (5) facility resident records was conducted. A review of (5) facility staff records was conducted. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and a copy was given to the facility co-Administrator at this time. Exit Interview