Routine inspection·September 24, 2024

Licensing Program Analyst (LPAs) Marcela Yanez and Simi Rai conducted an unannounced Required 1 Year visit. LPAs met with Lead Caregiver (S1), Rose (Rosalia) Calungcagin and stated the purpose of today's visit. S1 notified Licensee/Administrator Leilani Cortes of LPAs' visit and S1 stated Licensee/Administrator was busy at the time and unable to be present during today's visit. LPAs observed 2 staff in the facility, 5 residents at the facility and 1 resident out of the facility. LPAs observed 3 cameras in common areas of the facility. S1 stated the cameras only record video and no audio. LPAs observed 1 staff bedroom where in the door does not have locking capabilities. Staff S1 stated she resides in the staff room by herself. LPAs observed 7 day pill box on top of a table in staff room which was unlocked and accessible to residents in care . S1 stated the pill box belongs to her and the pill box contains prescription medication and vitamins. S1 removed the medication pill box and placed it in locked facility closet. LPAs observed office area which was converted to a living space for staff S2. LPAs observed a foldable mattress and S2's medication in a paper bag which were not locked and accessible to residents. S1 and S2 confirmed S2 is a live-in staff and sleeps at night in the office area 7 days out of the week. LPAs toured the facility kitchen and observed food supply of at least 2 days of perishable food and 7 days of nonperishable food. LPAs at random inspected 10 canned foods and observed 2 cans of food and 2 yogurts cups that had expired. While touring the kitchen LPAs observed a small pill cup contained 2 medication tablets which was left unattended in the kitchen cabinet which did not have locking capabilities. LPAs also observed 2 knives and 1 multi-purpose scissors on the kitchen counter, hidden underneath a kitchen towel by S1, which was unlocked and accessible to residents in care. Fire extinguisher located in the kitchen was observed last serviced on 01/20/2024. Continuation on LIC 809-C, Page 1 of 3. Page 2 of 3. LPAs observed 4 resident bedrooms. LPAs observed resident R1 was laying in bed and LPAs observed the bed was attached with full bed rails. S1 stated R1 was not under Hospice Services at this time. LPAs observed 1 bottle of hydrogen peroxide in resident R3's bathroom cabinet unlocked and accessible located in R3's bedroom. LPAs toured the garage and noted the door to the garage was unlocked during inspection. LPAs observed drawers in the garage, drawer which contained toxic chemicals such as Disinfecting wipes, Dishwasher Detergent and Spackle and tools such as Box Cutter Razor Blade, Hammer and Wrench. LPAs observed the garage drawer was unlocked and accessible to residents in care. Laundry area was observed laundry detergent was locked and inaccessible to residents. During visit, LPAs toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPAs observed 1 shed which contained tools that were accessible to residents in care. The shed door was not locked and staff had placed a round brick to stop the door from opening. LPAs observed 1 locked shed used for storage space. Both sheds were used as storage space and not habitual space. LPAs observed a pool in the backyard with two gates door which were locked and inaccessible to residents. LPAs observed Chlorine tablets near the pool filter in an unlocked gated area. LPAs observed all windows and screens in good repair and working condition. During inspection LPAs observed facility disaster drill which was conducted on 09/01/2024. LPAs inspected 3 bathrooms which all had non slip surface and grab bars in the showers. LPAs observed hot water temperature measured by thermometer which ranged from 108.9 - 109.2 degrees F. LPAs observed 1 prescription lotion, 3 ointment bottles and 1 multi-purpose scissors in the cabinet in Bathroom #1 which were unlocked and accessible to resident in care. LPA Yanez reviewed and inspected resident files and medication at random for two residents and all medications were recorded on the Centrally Stored Medication Record. LPAs reviewed 2 staff files. LPAs observed staff S2 did not have Statement of Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders. Staff S1 confirmed S2 did not have the document in S2's file. Page 3 of 3. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. Technical Violation was provided during today's visit. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Licensee/Administrator was not present during exit interview. This report was reviewed with Lead Caregiver (S1), Rose (Rosalia) Calungcagin and a copy of the report was provided. Appeal Rights were provided.