Routine inspection·April 27, 2023

Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Golden Star Home for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Licensee/Administrator Estrella Valendo, and was granted access into the facility. LPA toured the facility. LPA observed the facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on March 2023 at the time of the inspection. All smoke detectors and carbon monoxide detectors were tested and found to be operational during the inspection. Emergency Generator was observed in the garage. Water temperature in residents bathroom measured at 111 degrees, within acceptable range of 105 to 120 degrees F. Water temperature in the staff bathroom also measured at 111 degrees and is within acceptable range of 105 to 120 degrees. There was sufficient perishable and non-perishable foods located in the kitchen. There are special provisions made for individuals with special dietary needs. Food menu was presently available for viewing during the inspection. Medications were centrally stored and locked. Medication Assessment Record (MAR) was also observed. First Aid kit was inspected and found to be appropriate during the inspection. Cleaning products and other toxins are located in the laundry room that was locked and inaccessible to residents in care. There was a supply of Linens, cleaners, hygiene products and paper products available for residents. All bathrooms designated for residents in the common areas at the facility were supplied with individual paper towels and hand soap. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. A tour of all residents bedrooms were conducted, and bedrooms inspected have lighting and appropriate furnishing. LPA discussed the Infection Control Plan with the Licensee. LPA discussed the Emergency Disaster Plan with the Licensee and learned during interviews with both staff members that the Emergency Disaster Drill was last conducted on December 2022, but no documentation was retained in the Emergency Disaster Drill file. (See LIC 809D). (Report continued on LIC 809C) LPA educated on the importance of conducting Emergency Disaster Drills quarterly and retaining evidence of that in the Emergency Disaster Plan documents. LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has PPE which is stored in the entrance of the facility and observed to be sufficient at this time. During the Required 1 year inspection, LPA reviewed 2 of 2 resident files and found those files to be appropriate during the inspection. LPA interviewed 2 of 2 residents. LPA reviewed 2 of 2 staff member files and learned that both staff members do not have sufficient training hours (See LIC 9102-Technical Advisories). LPA interviewed 2 of 2 staff members. LPA requested the following documents to be sent: LIC 500- Personnel Report LIC 308- Designation of Responsibility LIC 309- Administrative Organization LIC 400- Affidavit regarding Client Cash Resources Updated facility sketch Updated Emergency Disaster Plan (LIC 610D) Surety Bond Most up-to-date Liability insurance Control of Property Register of residents Evidence of the next Emergency Disaster drill Deficiencies are cited from the California Code of Regulations (CCRs), Title 22, Division 6, Chapter 8 and the Health and Safety Code. Failure to correct the deficiency and/or repeated deficiencies within a 12-month period may result in civil penalties. Exit interview was conducted with the Administrator and appeal rights were given along with this report.