Routine inspection·February 3, 2023

On 2/3/2023, Licensing Program Analyst (LPA) D. Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and met with Lead Staff, Andes Vilaluz. The Licensee, Thelma Sy was contacted and notified of the visit. The facility currently provides care for 4 clients all of which were present at the time of visit. LPA arrived at the facility and had temperature checked and logged. LPA continued with a tour of the facility with Lead Staff; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Client’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher located in the kitchen was found to be last charged on 6/8/2022 at the time of the visit. Smoke and carbon monoxide detectors were inspected 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 balanced meals and alternative options for clients. The facility follows appropriate dietary measures based on client medical orders. LPA conducted a sample file review and found all staff to have current CPR and 1st Aid certification on file. Toxins are stored in a locked cabinet located in the garage and under the kitchen sink found to be secured. Sharps were observed to be kept locked in a designated drawer located in the kitchen. There was a supply of hygiene products and paper products available and kept in client individual bedrooms. Facility provides additional hygiene product to clients when requested and located in hallway closet. Facility has restrooms equipped with paper towel and soap dispensers. All client bedrooms have lighting & appropriate furnishings. Medications and facility records are stored in designated cabinets located in the hallway and found to be secured. Clients were observed to be in their respective bedrooms watching movies and in the kitchen with staff preparing lunch. Upon interviews, LPA found that clients appear to be comfortable interact well with staff. Continued onto LIC809-C Licensee, Thelma Sy's Administrator Certification 6021330740 expires on 10/25/2024. LPA was notified that Lead Staff, Andes Vilaluz is currently in the process of becoming the new Administrator for the facility. LPA reviewed CCLD Administrator Certification check and found that Andes Vilaluz's certification 6065602740 was received as of 10/24/2022 and pending for completion. Infection Control: Facility has completed an Infection Control Plan and submitted CCLD for review. All clients and staff are vaccinated with no symptoms. Posters have been posted throughout the facility for staff and clients ensuring COVID procedures. Facility has a station at main entrance for screening, hand sanitizer and other items designated for visitors and staff. Staff and clients are observed for symptoms and temperature on daily basis or based on change of condition. No deficiencies cited during today's visit. LPA requested the following documents be sent to CCL by COB 2/17/2022: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility client’s/client’s Copy of Administrator Certificate(s) Copy of Liability Insurance Copy of Surety Bond