Routine inspection·June 21, 2024

At approximately 9:00 AM, Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced annual required inspection of this licensed senior care facility. LPA was greeted by caregiver, Meriam Binalirao. Licensee, Alicia Poquiz arrived shortly after at approximately 10:45 AM. The facility is a single story home licensed for two (2) ambulatory residents, four (4) non-ambulatory residents and a hospice waiver capacity of three (3). The facility currently provides care for seven (7) residents. Facility is operating above the licensed capacity. Six out of seven residents were at home. Two out of seven was sleeping in her room, two out of seven were in the living room watching television, two of seven were outside smoking, and one of seven was away with his father. In addition, there are two (2) residents with a diagnosis of dementia At approximately 09:15 AM, LPA and Caregiver toured the building and grounds which was found to be clean. All notices that are required to be posted have been posted and are in a highly visible area. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins are stored in a locked cabinet in the facility garage but some toxins found unsecure.. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in the kitchen drawer. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. LPA advised Caregiver all hallways and non-private bathrooms are required to have night light Water temperature measured within regulation between 114 and 118 degrees F at three of three faucets accessible to residents. One out of one fire extinguisher was inspected and charged. Nine out Nine interconnected smoke detectors and two out of two carbon monoxide detectors were present, inspected and found to be in working order. There was enough lighting in all common areas and resident rooms. Continued on 809C Continued from 809 Medications located in designated cabinet were found to be secured. LPA conducted a spot check of medications and found medication administering pre-pouring error. Per approved Fire Inspection Facility Sketch dated 07/22/2022, Licensee is using designated Resident Bedroom #2 as a Staff Room and designated Staff Bedroom as a Resident Bedroom. In addition, the two Extra bedrooms located next to the designated Staff Room is being used as Resident Rooms. Licensee to provide updated Facility Sketch to CCLD for new Fire Inspection Request. At approximately 10:30 AM, LPA reviewed Seven of Seven resident records which were all found to be well organized. At approximately 11:39 AM, LPA reviewed two out of two staff records which were all found to be well organized. Medication records contained physician's orders for each resident. Administrator Annabelle Antonio Administrator Certification 7028257740 is current and expires on 11/20/2024. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report LIC9020 Register of Facility Clients/Residents LIC610- Disaster Plan (to include non-local evacuation site) Dementia Care Plan Job Description/Personnel Policies Evidence of Liability Insurance 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, may result in a civil penalty assessment. This report was reviewed with Alicia Poquiz and Appeal rights were given.