Routine inspection·September 28, 2023

Licensing Program Analyst (LPA), Carol Fowler is conducting an Required-1 Year inspection, on 9/28/2023 at approximately 02:00pm, and met with Helen Rabago, Administrator. LPA observed two on duty during the inspection. Currently four (4) client in care. Facility has an approved fire clearance four (4) ambulatory and (2) two bedridden clients. The facility has required emergency disaster plan. Facility scheduled evacuation fire drill was conducted on 07/12/2023, including staff & client. Client,1 out of 1, special diets regarding food are followed per staff interviews, and per LPA's observations during the inspection. The LPA reviewed four (4) staff files. Administrator certificate for Helen Rabago is current-#6021326740, expires 10/28/2024. All staff have required criminal record clearance. All staff have required training. The LPA reviewed four (4) client files. Client files were complete. The LPA toured the facility with the Administrator. All exits were unobstructed. The facility fire extinguisher was serviced and tagged as required expires 04/08/2023. Facility had six (6) smoke alarms, and all were working properly when checked during the inspection. Facility had one (1) carbon monoxide detector that were working properly when checked during the inspection. Facility had a first aid kit stored in the hallway storage, it did have a required first aid booklet. The facility had a sufficient supply of perishable and nonperishable food. Continue on LIC809C The facility had food, water, and emergency supplies to meet the 72 hour shelter in place requirement. The facility had a sufficient supply of personal protective equipment(PPE) for use as needed. The facility had a sufficient supply of hygiene supplies, cleaning supplies, and paper products for use as needed. The LPA observed the facility to be clean and orderly during the visit. The LPA observed that resident rooms, common areas, hallways, and bathrooms had sufficient lighting for clients in care. Clients rooms had required accommodations per regulations. Facility had all medications locked up and inaccessible to clients in care as required. During the tour LPA observed the following deficiencies: unlocked toxins (cleaning supplies) no staff member who has cardiopulmonary resuscitation (CPR) training and first aid training on duty LPA is requesting the following forms be updated and submitted to CCL by 10/11/23: · LIC 500 -Personnel Report · LIC 610 - Disaster Plan · LIC 308 - Designation of Responsibility · LIC 308 - Copy of Administrator Certificate · Infection Control Plan If updated Control of property Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and copy of report and appeal rights given.