Routine inspection·January 17, 2024

On 1/17/2024 Licensing Program Analyst (LPA) Murial Han conducted an unannounced annual inspection. LPA met with administrator, Roxanne Eduarte and explained the purpose of today's visit. LPA toured the facility's building and grounds. This is a two level home. Upper level is for facility care staff and ground floor is where the residents live. There are 4 bedrooms (2 shared and 2 private) for the residents and 2 full bathrooms. All rooms for residents are non-ambulatory. 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 105-108 degrees F. LPA inspected the kitchen and dining room area. Dining room area is observed as clean and in order. Both fresh food and frozen food supplies are inspected and observed as in place in the kitchen. Dry goods/emergency food supplies are in place also being stored in the garage. LPA observed central stored medication, toxins and chemical were locked and inaccessible to residents. LPA observed sharps in the kitchen were unlocked and accessible to residents in care. Facility is equipped with smoke detectors and carbon monoxide detectors. . LPA reviewed 4 resident records and all of them contained physician's report (LIC 602); however missing admission agreement, appraisal service needs and plan, pre-admission appraisal and safeguards for resident's personal belongings and valuables. LPA reviewed 3 staff files (one of them is the administrator) and all of them contained personnel records, health screening, First Aide/CPR, fingerprint cleared, however, none the staff members are associated to the facility. LPA requested documents to update administrator- A written letter from the Licensee appointing the current administrator for the facility, administrator certification, LIC 500, LIC 501 and LIC 308 to be submitted to CCL by 1/19/2024. 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 the administrator. A copy of this report and the appeal rights were provided.