Routine inspection·December 15, 2023

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA met with facility staff Melody Corpuz, and explained the purpose of the visit. Facility staff contacted Administrator Moddie Andaya, which stated he will arrive after completing a Christmas Party for another care home. Administrator Moddie arrived later during the visit to meet with LPA Valerio. LPA Valerio and facility staff toured the physical plant to ensure compliance with Title 22 regulations. LPA inspected 6 resident bedrooms, 1 staff area, kitchen area, common area, 2 bathrooms, garage area, and exterior plant. Resident bedrooms were equipped with required furniture, were observed to be clean without any odors, and free from debris. The kitchen was observed to be clean and to have sharps locked away and inaccessible to residents. The facility was observed to have a minimum of 2 days of perishable food items, 7 days of non-perishable food items, and an emergency supply of food. Bathrooms were equipped with non-skid mats, toilet paper, paper hand towels, soap, and a trash can. Hot water temperature was measured between the regulatory range of 105.0*F - 120.0* degrees F. Fire extinguishers were observed to be fully charged with an annual inspection on 03/03/2023. LPA observed the exterior plant to be clean, have areas for outside visits, and to have no obstructions of emergency exits. LPA spoke to facility staff and a resident during the visit. Staff were observed cleaning the facility, checking in on residents, and assisting with a facility visitor. Residents were observed dancing in a chair to Christmas music, watching television, and taking a nap. LPA reviewed staff files and resident files. LPA observed 2 staff files to be current with up to date training. Three (3) resident files were reviewed. 1 out of 3 resident files were observed to be incomplete. LPA requested the following documentation be sent to the San Bruno Regional Office: LIC 309 Administrative Organization, LIC 500, LIC 308, LIC 610E, and Copy of Liability Insurance. Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached LIC 809 - D. Appeal Rights were provided. An exit interview was held with Administrator Moddie, and a copy of the report was provided.