Post-licensing visit·December 28, 2023

On 12/28/2023, Licensing Program Analyst(LPA) Murial Han conducted an unannounced post licensing inspection. LPA was greeted by caregiver, Norma Solis. LPA explained the purpose of the visit. After LPA toured the facility with the caregiver, administrator, Christopher Cayabyab arrived and assisted with the rest of the inspection. LPA toured the facility inside and outside including the bedrooms (2 shared rooms), 1 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. Bathroom is equipped with grab bars, and nonskid mats. Facility temperature is comfortable. Hot water temperature was measured at 130-137 degrees F. During the tour of the facility, LPA did not observed adequate outdoor area/space for residents. This observation was shared with the administrator and possible plan of correction was discussed. Central stored medication, toxins and sharps objects were locked and inaccessible to residents. LPA reviewed 1 resident record and it contained admission agreement, medical assessment- LIC 602 (Physician Order), Appraisal Needs and Service Plan Resident Identification information, Pre-appraisal assessment, etc. LPA reviewed 1 staff file and it contained personnel records, Health Screening Report, Abuse Statement, First Aide/CPR, Criminal Record Statement, fingerprint cleared, etc. Food supplies were observed to be adequate. Facility is equipped with smoke detectors and carbon monoxide detectors. Fire extinguishers were last serviced on 11/7/2023. Disaster drills records were reviewed. LPA reviewed the P & I records and observed Record of Client's/ Resident's Safeguarded Case Resources (LIC 405) and receipts for 1 resident. During today's inspection, there are no resident present as the resident is attending the adult day program. 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 appeal rights were provided.