Routine inspection·May 22, 2024

At approximately 8:30 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a 1-Year Required Visit and met with Staff Member, Mark Cabugwas who was the only staff member present. LPA was informed that there are 4 clients in care and all were away at day program, which is Monday - Friday from 8:00 AM - 3:00 PM. Licensee/Administrator, Josephine Sana was contacted and arrived at approximately 8:50 AM. Facility is a Residential Care Facility for the Elderly (RCFE) with 1 dementia client in care. Facility has an approved fire clearance and capacity for 4 non-ambulatory clients. At approximately 8:55 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. Two cabinets in communal areas containing cleaning supplies and other items that could pose a risk were observed unlocked. Licensee removed the items immediately and placed them in a locked cabinet in the locked garage. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked. There is outdoor space for activities. LPA observed toys, games, ipads for each resident, an activity schedule, musical instruments and other supplies for client activities. The facility is hardwired with automatic fire doors, which were tested and operational. Fire extinguisher was last serviced July 2023. Smoke and Carbon Monoxide detectors were tested and operational during inspection. Facility conducts regular monthly disaster drills, and the most recent drill was conducted April 2024. LPA observed the facility's infection control plan, first aid kit, emergency supply of water, PPE, and other emergency supplies. Licensee states facility has a back-up generator if one is needed. LPA reviewed facility's emergency disaster plan and plan of operation and informed Licensee that both need to be updated to make considerations for clients with dementia. Licensee updated the facility's emergency disaster plan during visit and submitted it to LPA. Continued on 809-C... At approximately 9:45 AM 5 staff files and 4 client files were reviewed. All staff have required CPR and First Aid training certificates. LPA observed 2 of 5 staff do not have the required LIC503 - Health Screening signed by a physician and 1 of 5 staff files had LIC501 - Job application missing the staff member's signature. LPA also observed 1 of 5 staff files deficient in both annual and dementia training hours. LPA observed 5 of 5 staff files contained all the remaining required documentation. LPA reviewed 4 of 4 client files and observed 1 of 4 with their individual service plan not signed by the responsible party. LPA observed that 4 of 4 client files had all the remaining required documentation per regulation. Facility coordinates and takes the clients to their medical and dental appointments as needed. LPA reviewed medications and medication records which are maintained in compliance with regulation. LPA reviewed P&I monies and logs, which were organized and maintained according to regulation. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: Proof of Staff Training Staff Health Screenings Signed by Physician Signed Client ISP LIC610D- Disaster Plan Updated Plan of Operation to include Dementia Care 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. Exit interview conducted with Licensee whose signature on this document confirms receipt . This report was reviewed with Licensee and Appeal Rights were given .