Routine inspection (multi-day)·April 28, 2023

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to continue the Required - 1 Year inspection and met with, Administrator, Magdalena Casuga and Aileen Bryant. This facility is licensed for a total of 6 in which 4 of the residents may be non ambulatory. Facility does not have approval for bedridden, or Hospice. There are currently 4 residents living in the home, of which one (R1) is out of the facility receiving rehabilitation services due to a recent hospitalization due to a hip fracture from a fall. LPA toured facility and grounds and observed facility was found to be clean at a comfortable temperature, with all exits free from obstruction. Facility has at least two days of perishable and one week of non-perishable foods. Fire Extinguisher was found to be charged, and serviced 2/28/2023. Smoke alarms and Carbon monoxide detector are operational. Facility has ceiling fire sprinklers that are serviced and the last inspection was conducted on 3/7/2023. Facility last fire drill was conducted on 3/15/23. LPA previously reviewed all resident files, and some staff files. Staff S1 was fingerprint cleared but facility accidentally noted the wrong facility number and S1 was associated to a sister facility, Nena & Rays Guest Home #3. S1 works at both Nena & Rays Guest Home #1 and #2 that are combined in this duplex type home and was not associated to either facility. Facility will send in copy of staff S1s who was recently hired health screening. LPA consulted regarding staff training that was documented but lacked information from a qualified vendor, certificates or proof of training material. Continue report see LIC809C Medication is centrally stored and locked in the office. Facility uses the centrally store log and the Medication Administration Record (MARs). Residents medication is separated in small closed boxes per resident and include an additional list of medication list attached to the top of the container as extra precaution. LPA toured the wrap around outdoor yard that is fenced. Facility stated some residents come out to smoke in the evening and like to at times be outside in the yard during the day. LPA went over staff being present in the yard at all times residents are out there, to provide supervision and for the residents safety. Facility has sensor motion Lights throughout the yard and in the facility hallways and/or night lights. The following deficiencies were observed (see LIC 809D) and 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 and appeal of rights provided. Administrator and LPA discussed their Emergency Disaster Plan and Infection Control Plan. Licensee/Administrator to submit the current following documents by 5/21/2023: · LIC 308 Designation of Facility Responsibility · LIC 500 Personnel Report · LIC 400 Affidavit Regarding Client/Resident Cash Resources · LIC 610E Emergency Disaster Plan · LIC 9020 Register of Facility Residents Infection Control Plan of Operation (If changes) Liability Insurance Copy of current Lease Agreement Current facility sketch