Routine inspection·July 30, 2024

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit and met with Lead Staff, Ellenelsa Lopez and stated the purpose of today's visit. LPA Rai spoke with Administrator, Fe Literato-Hilario and stated the purpose of today's visit. LPA Rai observed 3 staff and 6 residents at the facility. All 3 of 3 staff were criminal record cleared and associated to the facility. During visit, LPA Rai toured the inside and outside of the facility. LPA Rai observed required posters hanging on the walls of the facility, near the front door and living room. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed 4 storage sheds that was not used as habitual space. LPA Rai observed the fence shared with the facility on the right side facing the facility from the main street was being replaced and Lead Staff stated they supervise residents when using the backyard. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the facility bedrooms. 5 out of 9 bedrooms are being occupied by residents. Rooms had available bedding, drawers, and functioning lights. 4 Out of 9 bedrooms are being occupied by staff who are criminal record cleared and associated to the facility. The facility bathroom had available soap, paper towels, and trash cans with lids. The water temperature in the bathroom sinks ranged from 112.5 degrees F - 114.5 degrees F . The water temperature in the kitchen sink was 108.1 degrees F . Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. Fire extinguisher was observed and inspected on 10/01/2022 and ADM provided receipt for fire inspection renewal on 05/19/2024. Facility smoke detectors and carbon monoxide detectors were in working condition. The last disaster drill was conducted on 06/03/2024. LPA Rai reviewed facility records for 3 staff and 3 residents. Based on review staff (S1)'s file, S1's first aid was expired and did not have updated first aid training. LPA Rai reviewed resident medications and central stored medication records. Based on review of 1 resident (R2), Centrally Stored Medication Record/Log, 1 centrally stored prescription medication was not logged on the document. Based on review of resident R2 and R4's file, 2 out of 2 resident records did not have a written order from a physician indicating the need for the postural support, such has the half-bed rail for mobility. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. Technical Assistance was provided. This report was reviewed with Lead Staff, Ellenelsa Lopez and LPA Rai reviewed this report with Administrator, Fe Literato-Hilario over the phone. Administrator verbally agreed and understood. A copy of the report was provided and Appeal Rights were provided.