Routine inspection·June 5, 2023

Licensing Program Analyst (LPA) Karina Canela arrived for the purpose of conducting a Required -1 Year inspection and was granted access into the facility by Suzette Hojilla, Caregiver. Administrator Lovelyn Hojilla arrived later. LPA toured the facility, all exits were unobstructed. The facility was found to be at a comfortable temperature. LPA observed a supply of linens (bedding, towels, etc.), and cleaning solutions (observed locked & inaccessible). Resident bedrooms were furnished per regulation. Facility food supply was within regulation and accessible to clients. Medication was centrally stored. Water temperature was tested and observed between 105 to 120 degrees F. Disaster Drills are conducted quarterly as required. Fire extinguisher was charged and serviced 04/07/2023. There are 8 smoke detectors & 1 carbon monoxide detector, which were tested & observed operational. LPA reviewed staff and resident records. Staff have current training certifications in First Aid & Cardiopulmonary Resuscitation (CPR) in file. LPA addressed fire clearance and postural supports deficiencies on continued page (LIC809-C). LPA discussed regulations 87465(h)(5) , 87463(c) , 87463(a) ; and discussed Health & Safety Code 1569.696(a)(1) & 1569.625(b)(2) LPA requested the following updated forms to be submitted to Community Care Licensing by 07/06/2023: · LIC 308 Designation of Facility Responsibility (1 person per form) · LIC 500 Personnel Report · LIC 400 Affidavit Regarding Client/Resident Cash Resources (indicate if not handling cash for residents) · Copy of Liability Insurance · LIC 9020 Facility Register of Client/Residents · LIC 610E Emergency Disaster Plan · Copy of current Administrator's Certificate Report continued on LIC809-C Deficiencies observed: Fire Clearance Violation: During inspection, LPA observed 1 shed in the backyard on the facility property with a bed, television, dresser, air conditioner, food, and personal belongings (photos taken). Staff (S1) stated they live in the shed with their partner non-client adult resident (NCAR). Administrator stated the shed is a relief room for staff staying over night; S1 and NCAR stay in the staff room inside the facility adjacent to the kitchen. LPA discussed with Administrator that the shed is required to be inspected and approved by the Vacaville Fire Department to ensure it is safe for staff to occupy. Administrator understood. Additionally Administrator disclosed Resident (R1) occupying bedroom #1 is bedridden, as they can't turn in their bed and can't ambulate without the use of a wheelchair. LPA discussed with Administrator that the Vacaville Fire Department approved bedroom #5 for bedridden (per facility sketch received 05/20/2020) and bedroom #1 is approved for only non-ambulatory. Postural Supports Violation: During inspection, LPA observed 5 of 5 residents with half-rails (photos taken). LPA discussed with Administrator that half-rails are only allowed if the resident's medical physician provides an order for half-rail to be used for mobility and support per regulation. Administrator stated they understood. **An immediate civil penalty in the amount of $500 was assessed today for the fire clearance violation. Deficiencies cited (see LIC809-D page) from the California Code of Regulations, Title 22, Division 6. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Appeal Rights Provided. Exit interview conducted with Administrator, whose signature on this document confirms receipt. Due to printer issues, this report was emailed to Administrator