Routine inspection·August 1, 2024

At approximately 9:30 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a 1-Year Required Visit and was greeted by a caregiver. Alma Corsiga, Licensee, was contacted by phone and arrived at approximately 9:45 AM. LPA was informed there were six (6) residents in care; two (2) were away at Day Program and four (4) were present during inspection. Facility is a Residential Care Facility for the Elderly (RCFE) with an approved dementia plan and fire clearance for capacity of six (6) non-ambulatory residents. At approximately 10:00 AM, LPA initiated a tour of the facility and observed the following: Facility is a one-story home, was a comfortable temperature, and passageways were free from obstructions. Water temperature in clients' bathrooms measured within the allowable range of 105 to 120 degrees F per Title 22 regulations. LPA observed client showers with grab bars an non-slip mats as required. LPA observed a supply of clean linens, incontinent care products, and paper products available to clients. Clients' bedrooms were inspected and observed to have appropriate furnishings as outlined in Title 22 regulations. LPA observed three residents in their respective beds. Two of whom showed their ability to move and reposition themselves. Cabinets in communal areas containing cleaning supplies and other items that could pose a risk were observed unlocked. Licensee had staff remove the items immediately and place them in a locked cabinet. Facility has at least two days of perishable foods and a supply of non-perishable foods. Medications were centrally stored and locked. There is outdoor space for activities. LPA observed toys, games, video games, and an ipad for resident use. Facility has a fire extinguisher, which was last inspected May 2024 as is fully charged. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Continued on 809-C... Continued from LIC 809... At approximately 12:15 PM, five (5) resident files were reviewed. LPA observed one (1) resident (R1) file with a physician's medical assessment from May 2024 indicating said resident is bedridden. Facility's fire clearance does not contain approval for bedridden residents. LPA observed 3 of 5 resident files missing the required I.D. and Emergency Information form and 5 of 5 resident files were missing consent for emergency medical treatment. LPA observed all the remaining required documentation per regulation in five (5) of five (5) resident files. Licensee states facility coordinates the residents' medical and dental appointments as needed and provides transportation to and from these visits. At approximately 1:45 PM LPA initiated file review of five (5) personnel files but was unable to complete the review. LPA was also unable to review medications, P&I, and facility's emergency disaster drill log and will return at a later date to complete annual inspection. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights provided to Licensee. Exit interview conducted with Licensee, whose signature on this document confirms receipt . Updated copies of the following documents are to be submitted to CCL within 30 days of this visit : LIC 200 Request for Bedridden Fire Clearance LIC 999 Updated Facility Sketch LIC 500 Personnel Record (updated) LIC 610 Emergency Disaster Plan (updated) LIC 9020 Register of Facility Resident’s Proof of Liability Insurance