Routine inspection·September 17, 2024

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a Required - 1 Year inspection and met with Administrator/Licensee, Rafael and Rose Aquino. There are currently 5 residents in care. There were 2 staff at the time of inspection. This facility is licensed for 6 non-ambulatory residents, with hospice waiver approved for 1 of the resident and none of the residents are approved for bedridden. LPA toured facility and grounds and observed the home organized and at a comfortable temperature with all exits free from obstruction. Exit doors have auditory alarms to alert staff. The fire extinguisher located in the kitchen was observed charged and serviced on 09/10/2024. Fire drills have not been documented. LPA requested Fire Drill to be conducted and proof sent to CCL. Water temperature in the resident bathroom was tested and found to be within appropriate range of 105-120 degrees. Bathrooms have required non-skid surfaces and grab bars. Cleaning products and knives are stored in locked cabinets in the kitchen and the laundry room. There was a 7 day supply of non-perishable foods. There are adequate dishes, glasses and silverware. Residents' medications are stored locked. Resident and staff files are located and locked in cabinet. LPA reviewed staff files and staff have proof of CPR/1st aid. LPA requested proof of yearly training. Resident files were reviewed and found to be complete, except for Consent for Medical Treatment. LPA left copies for each resident/DPOA to complete. Continued on 809-C Continued from 809 Licensee/Administrator to submit the following documents by 10/10/24: · LIC 500 Personnel Report · Proof of Staff Trainings · Copy of Liability Insurance and Documentation of Emergency Drills No citations issued at this time.