Routine inspection·August 17, 2023

Licensing Program Analyst (LPA) Carol Fowler conducted a Required- 1 Year visit, on 8/17/23 at approximately 9:30am, and met with Primaeudelyn Rabena, Caregiver. Administrator Rosalina Lubuguin arrived at approximately 10:15am. Certificate, #6010923740, is current- expires 02/09/2024. LPA observed two caregivers working at the time of arrival. There are currently five (5) residents in care. Facility has a required infection control plan. Facility has an emergency disaster plan as required. The facility conducted a fire drill and an earthquake emergency drill on 06/30/2023. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. All exits were free and clear of obstruction. Fire extinguisher, was last serviced on 2/19/2023 and tagged as required. LPA observed nine (9) smoke alarms and two (2) carbon monoxide detectors, working properly during the inspection. Facility was found to be clean, orderly, and at a comfortable temperature. Hot water was checked at 114.9 F, which is within regulation. Medications were stored and locked making them inaccessible to residents. There was a sufficient supply of hygiene products, cleaning supplies, and paper products for use as needed. All bathrooms had grab bars, and non-slip mat/flooring for bathing/showering as needed. Facility has a sufficient supply of personal protective equipment(PPE) for use as needed. LPA observed sufficient supply of food, perishable and non-perishable for residents in care. Continue on LIC809C Continue from LIC809 There are currently five(5) residents in care. LPA reviewed five(5) of five(5) resident files; All resident files were found to be complete. LPA reviewed three (3) of three (3) staff files. LPA reviewed staff training. All three (3) staff have criminal record clearance, and are associated as required. All staff had required annual training. All staff had current First Aid and CPR Certification. LPA is requesting the following documents be updated and submitted by 8/24/23: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to provide all information in all boxes as required) Infection Control Plan-if any changes, as discussed Copy of Current Liability Insurance Copy of current Administrator Certificate During the tour of the facility, the LPA observed poles on small chairs blocking off the patio/deck area of the home, which poses a tripping hazard that has wood planks ladders and buckets accessible to residents in care. There is no railing/fencing. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with the Administrator. Appeal rights were provided.