Routine inspection·January 16, 2025

Licensing Program Analysts (LPAs) Christine (Dolores) Kabariti and Marcela Yanez arrived unannounced to conduct the facility's annual required - 1 year inspection. LPAs met with Administrator (ADM), Belinda Devano. During visit, LPAs toured the facility with ADM to include the living room, resident bedrooms, staff bedroom, bathrooms, kitchen, garage, and backyard. There are 5 residents under hospice care. All fire exit routes were free and clear of obstruction. 4 staff present are fingerprint cleared. 3 out of 4 staff are associated to the facility. 1 out of 4 staff present was fingerprint cleared but was not associated to the facility. During visit, the ADM associated the staff to the facility using Guardian. ADM was advised to ensure all staff are associated to the facility prior to work. Facility temperature maintained at 72 degrees F. Fire extinguisher last serviced on 06/04/2024. Carbon monoxide detector observed present and operable in the hallway next to the kitchen. Smoke detectors observed throughout the facility. First aid kit observed complete. LPA observed Personal Protective Equipment (PPE) supplies. Emergency lighting such as lanterns and flashlights observed in the facility. Facility is conducting fire drills quarterly and the last drill was completed on 01/03/2025. 5 out of 5 resident bedrooms observed equipped with proper furniture and lighting to include a bed, linens, night stand, and dresser. 4 out of 5 resident's who are under hospice observed with full bed rails. Based on record review, 4 out of 5 residents hospice care plan included the physician order for full bed rails. 2 residents used oxygen. Oxygen in use sign observed posted outside the resident bedrooms. See LIC809-C. Around 11:20AM, the hot water temperature was measured in the bathroom next to bedroom #1 to be maintained at 102 degrees F. ADM states the hot water temperature is low because in the morning they use a lot of hot water. ADM states the hot water should raise in the afternoon. At 1:30PM, the hot water temperature was measured at 121.8 degrees F. Bathroom showers are equipped with grab bars and non-slip mats. Sharp objects, chemicals/toxins, and medications observed locked. Facility has at least 2 days worth of perishables and 7 days worth of non-perishable foods. Refrigerator temperature in the kitchen measured at 34 degrees F. Freezer temperature in the kitchen measured at 0 degrees F. There are 2 additional refrigerators in the garage which stores more food for the residents. The refrigerator in the garage temperatures measured at 40 degrees F and freezer measured at 0 degrees F. 3 resident files were reviewed. 1 out of 3 resident files did not contain an appraisal/needs and services plan. ADM was unable to produce the appraisal/needs and services plan for the 1 resident. 2 out of 3 resident files contained an appraisal/needs and services plan. 3 resident files reviewed were up to date and maintained. 3 residents centrally stored medications and records were reviewed and all medications were accounted for. 2 residents were interviewed. 3 staff records were reviewed and observed complete and maintained. 3 out of 3 staff annual training were complete to include at least 20 hours of annual training. Posters observed to include but not limited to the ombudsman, complaint poster, theft and loss policy, admission agreement, and house rules. Documents were obtained to update the facility's file to include: LIC500, LIC308. LIC400, Liability insurance, proof of administrator certificate renewal, and page 9 of the emergency disaster plan. A deficiency was cited per California Code of Regulations, Title 22. See LIC809-D. Advisory note provided. This report was reviewed with Administrator, Belinda Devano and a copy of the report and appeal rights were provided.