Routine inspection·August 31, 2023

8/31/2023, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection visit for this facility and was greeted by Licensee, Danilo & Thelma Sy. The facility is single story building licensed for 4 non-ambulatory residents. The facility currently provides care for 1 resident, who is not receiving hospice services or has diagnosis of dementia. The resident is non-conserved and receiving consumer services under North Bay Regional Center. The resident was attending day program at the time of visit. LPA continued with a tour of the facility with Licensee, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 7/2/2023. Both smoke detectors and carbon monoxide detectors throughout the facility were tested and found to be in working order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations with additional food supplies in the garage. Facility also follows appropriate dietary protocol for resident in care. Toxins were located in the garage and laundry room and found to be secured. There was a supply of hygiene products and paper products available for resident. All resident bedrooms have lighting & appropriate furnishings. Water was measured at faucets accessible to residents and was within regulation. Medications located in dinning area were found to be secured. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Store Medication Record. Upon count LPA found all administered medication to be in order. LPA also conducted a file review for resident R1 and found all items including Physician's Report and Individual Program Plan to be updated. LPA toured the facility backyard and found all bedroom screens in good repair and found one emergency exits located in the side yard to be clear and unobstructed. Continued onto LIC809-C Licensees' Danilo Sy's Administrator Certification 6024440740 is valid until 10/25/2024 & Thelma Sy's Administrator Certification 6021330740 is valid until 2/20/2025. LPA requested the following documents be sent to CCL by COB 9/31/2023: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Liability Insurance Proof of ownership or lease/rental agreement No deficiencies cited during today's visit.