Routine inspection·February 12, 2025

*Amended to Correct Facility Name. At approximately 1:30 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Caregiver Leonida Arinzana. Facility Administrator Maria Salvador was not available for the Inspection. Designated Responsible Party (DRP), Christiane Salvador arrived at 1:45 PM. Highlands Care Home III, is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for five (5) non-ambulatory residents and one (1) ambulatory resident. The facility has a Hospice Waiver for two (2) residents. Upon arrival, LPA was informed that there were five (5) residents in care and one (1) staff members on-site. At approximately 1:50 PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 2:00 PM, LPA toured the facility with Administrator Salvador. All exits were clear and unobstructed. Fire extinguisher were last serviced and tagged in 3/2024. Fire Department inspected and cleared the fire alarm system in 1/2024. Food supply was sufficient. The facility was sufficiently lighted. LPA inspected four (4) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills quarterly. The last disaster drill was conducted on 11/2/2024. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and operational. Continued on 809-C ...Continued from 809 At approximately 2:50 PM, LPA reviewed four (4) resident files. Four (4) of four (4) resident files were found to have all required documentation. LPA reviewed four (4) staff files. One (1) staff file (S2) was observed to have a medical assessment and Tuberculosis test that was dated prior to six (6) months before employment. This deficiency will be cited. Four (4) of four (4) staff files were observed to have First Aid and CPR certification. Four (4) of four (4) staff files were observed to lack proper training documentation. This deficiency will be cited. LPA spot checked Medication for three (3) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. The Facility does not have an internet access device. This deficiency will be cited. Maria Salvador’s Administrator Certification 7004161740 is current with an expiration date of 3/21/2026. LPA requested the following documents be submitted to Community Care Licensing by 3/12/2025: LIC 500 Personnel Report LIC 308 Designation of Responsibility LIC 610D Emergency Disaster Plan Updated Lease Proof of Liability Insurance Exit interview conducted with Caregiver Leonida Arinzana. Copy of report, LIC809Ds (Deficiency Pages) with plans of corrections, Confidential Names (LIC811), and Appeal Rights discussed and provided to caregiver Arinzana. Signature on form confirms receipt of documents