Routine inspection·April 18, 2024

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual required - 1 year inspection. LPA met with Administrator, Violeta Dumo. During visit, LPA toured the facility with DSP to include the entrance, kitchen, living room, resident bedrooms, staff bedrooms, bathrooms, garage, and backyard. LPA observed a shed at the side of the facility which contains storage items. All fire exit routes are free and clear of obstruction. All present staff are fingerprint cleared and associated to the facility. Upon entrance, the facility has a visitor sign-in sheet. Posters posted at the entrance to include if you see something say something, ombudsman, and personal rights. Facility temperature maintained at 75 degrees Fahrenheit. Facility has carbon monoxide detector present in the hallway. Fire extinguisher last serviced on 05/18/2023. Facility's fireplace observed screened. Medication, disinfectants, cleaning solutions, and sharp objects observed locked. Facility has at least 2 days worth of perishables and 7 days worth of non-perishable foods. Trash bin with lid observed in the kitchen. Facility has an emergency disaster plan and emergency flashlights available. Facility conducted their last quarterly emergency drill in December 2023. Facility plans to conduct their next emergency drill this coming weekend. SEE LIC809-C. LPA observed the facility's Infection Control Plan and staff training on infection control. Facility has Personal Protective Equipment (PPE) supplies to include gowns, gloves, masks, hand sanitizer, and disinfectant supplies. 3 out of 3 resident bedrooms observed with furniture to include a bed, linens, lighting, dressers, closet, and night-stands. Bathrooms observed with grab bars and non-slip mats. Hot water temperature maintained at 116 degrees Fahrenheit. 3 residents files (R1 - R3) were reviewed. 3 out of 3 residents files contained an admission agreement, medical assessment, TB result, IPPs, personal rights form, consent forms, and safeguard of personal property and valuables form. R1 - R3's centrally stored medications and P&I money were inspected and observed maintained. 3 staff files (S1 - S3) were reviewed. 3 out of 3 staff files contained an updated 1st aid certification, fingerprint clearance, LIC501, LIC503, TB information, and training. LPA observed 1 out of 3 staff did not have a health screening form on file. Based on interview, the staff removed the sheet from the binder for another position and misplaced the form. Administrator states the staff's health screening report was obtained and reviewed prior to employment. Administrator will ensure to follow-up with the staff regarding the health screening form. LPA interviewed 5 residents and 4 staff members. The following documents were requested to include the LIC500, Administrator certificate, and liability insurance. No deficiencies were cited per California Code of Regulations, Title 22. Advisory note provided. This report was reviewed with Administrator Violeta Dumo and a copy of the report was provided.