Routine inspection·January 30, 2024

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual required 1-year inspection. LPA met with House Manager/Designated Administrator, Avelina Pascua. During visit, LPA toured the facility with the house manager to include the living room, dining room, kitchen, activity room, bathrooms, garage, resident bedrooms, and backyard. All fire exit routes were free and clear of obstruction. Carbon Monoxide detector present in the facility. Fire extinguisher last serviced on 01/10/2024. Facility temperature maintained at 78 degrees Fahrenheit. All staff present are fingerprint cleared and associated to the facility. Resident bedrooms observed well maintained with beds, clean linens, dressers, night stands, and adequate lighting. The facility has an approved exception request for resident (R3)'s postural supports. Bathrooms supplied with hygiene products, paper supples, and non-slid matts. Hot water temperature maintained at 112 degrees Fahrenheit in 2 out of 2 bathrooms. LPA reviewed 3 resident (R1 - R3) files to include an admission agreement, medical assessment, TB result, consent forms, emergency identification forms, safeguard personal property and valuables, and personal rights form. 3 out of 3 residents appraisal/needs and services plan were last updated in 2020. 2 out of 3 residents IPP was last updated in 2022. 1 out of 3 resident's file did not contain an IPP. Facility was advised. SEE LIC809-C. LPA reviewed 3 staff (S1 - S3) files to include an updated 1st Aid certification, health screening, TB information, employee rights, and personnel record. The facility was unable to produce staffs annual training to include dementia care, postural supports, restricted health conditions, and hospice care. The last training was completed in year 2022. Facility was advised. Facility's Emergency Disaster Plan was posted on the bulletin board located in the hallway and was dated in 2015 to include former staff members. LPA advised the house manager to update their emergency disaster plan. House Manager stated understanding. Facility has their facility sketch posted in a common area. Facility has extra flash lights and batteries. LPA observed the facility's first aid kit to be complete. Emergency drills are being conducted quarterly and the last drill was completed on 01/14/2024. Facility's Infection Control Plan was last updated in 2022. LPA advised the facility to update their infection control plan annually to ensure accuracy. Facility has a sufficient amount of PPE supplies, Posters and signs observed posted in common areas to include house rules, grievance, personal rights, complaint poster, ombudsman, and COVID-19 related resources. LPA interviewed 3 staff members. Documents were obtained to include the facility sketch and R3's admission agreement. LPA requested for the facility's certificate of liability insurance via email. Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with House Manager/Designated Administrator Avelina Pascua and a copy of the report and appeal rights were provided.