Routine inspection·August 3, 2023

On 8/3/2023, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Lead Staff, Frank Oboza . Administrator, Dinah Belandres and Licensee Rose Devera were contacted and arrived later in the visit. The facility is a single story home licensed for six non-ambulatory residents and a hospice waiver capacity of 3. The facility currently provides care for 6 residents, none of which are receiving hospice services and some of which with a diagnosis of dementia. LPA continued with a tour of the facility with Lead staff; Frank Oboza and Licensee, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 11/7/2022 at the time of visit. Both smoke detectors and carbon monoxide detectors throughout the facility were also tested and found to be functioning. Smoke detectors were also observed to be interconnected. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in the facility laundry room and under kitchen sink both of which were secured upon inspection. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in the kitchen cabinet. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Water was measured at faucets accessible to residents and measured between 116.6 and 119.1 degrees F which is within regulation. Continued onto LIC809-C Medications located in designated closet located in the kitchen were found to be secured. LPA conducted a spot check of medications and found all administering and records to be in order. Facility and resident responsible parties are responsible for picking up medications and keep track of refills ensuring orders are placed around the final 5-10 doses of prescribed medications. Resident were observed interacting with staff in the common area, watching game show television or interacting with staff for leisure. There is one emergency exit located in the backyard which was found to be unobstructed. All auditory alarms leading out of the facility including resident bedroom emergency exits were tested and all found to be in working order. LPA conducted a sample file review for staff and found all staff to have appropriate annual training and 1st Aid & CPR certification on file. LPA also conducted a file review for all residents. Upon review, LPA found that all resident Needs & Service Plans have been updated as of July 2023 but require signatures from resident responsible parties. Licensee agrees to contact resident responsible parties for signatures. Technical Advisory issued. During the tour of the facility, LPA observed the window screen and blinds located in resident's (R1) bedroom #3 in need of repair or replacement. Technical Violation issued. Licensee immediately contacted the facility maintenance staff who measured and immediately replaced the items during the time of visit. Licensee, Rose Devra's Administrator Certification 6008400740 is valid through 11/1/2024. Administrator, Dinah Belandres's Administer Certification is currently pending. LPA confirmed that the re-certification training and payments were received by the department as of 2/10/2023. LPA requested the following documents be sent to CCL by COB 9/3/2022: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Liability Insurance Control of Property/Rental Agreement No deficiencies cited during today's visit.