Routine inspection·November 2, 2023

Licensing Program Analyst (LPA) Christi Coppo and Licensing Program Manager (LPM) Bethany Moellers arrived unannounced to conduct a required Annual inspection and was greeted by Rhodener (Dennis) Panlican, co-administrator. Licensee Caroline Ramos arrived later at approximately 11:45am. Facility currently has 5 residents of which none are on hospice. Facility contact information was reviewed. At approximately 9:00am LPA, LPM, and Licensee toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA, LPM, and co-Administrator observed outside exit path to be partially obstructed by four shelving units, housing plants, and ceramics. LPA obtained photos and requested Licensee to remove all items so that pathway is fully accessible. Licensee agrees to have cement walkway from backyard area to emergency exit gate fully cleared and accessible. LPA and LPM advised path should be completely clear ensuring room for all residents to utilize path for emergency exit, as required by Title 22 regulation 87202(a). At approximately 8:55am LPA and LPM observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and labeled. Kitchen cabinet containing cleaning supplies was locked. LPA observed staff working in the kitchen with the sharp knives drawer unlocked. Licensee agrees to keep kitchen drawer containing sharp knives to be locked at all times, with the key removed and stored out of reach of residents. LPA observed staff to be in kitchen area working with medication cabinet unlocked and with keys in the lock. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required bath mats and grab bars. Water temperature in sink(s) accessible to residents in care measured at 108.2 F, 111.4 F and 111.2 F degrees F which is within the allowable range of 105 to 120 degrees F.. Report continued on LIC 809-C continued from 809... Fire extinguishers were last inspected April 28, 2023. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Exit doors have an auditory alert system that was functional at time of inspection. Facility’s last quarterly disaster drill was conducted on August 10,2023. Facility has a backup generator for use during a power outage At approximately 12:35pm LPA, LPM, and Licensee conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet in the kitchen. At approximately 12:30pm LPA and Licensee observed medication cabinet to be unlocked in the afternoon. Licensee agrees to keep cabinet locked at all times, with the key removed and stored out of reach of residents. At approximately 10:15am LPA and LPM conducted a review of 5 resident and 3 staff records. Current training courses and hours were not available for Arianna Panlican as required per Health and Safety Code 1569.625(b)(2). Caroline Ramos Administrator Certificate 6039775740 expired 5/17/2022; however, certificate is currently in Renewal-Pending status. All fees are current as of this time. LPA reviewed the facility's Infection Control Plan. Licensee provided the Infection Control Plan and will send copy of Infection Control Plan to CCL within 30 days. At approximately 12:45pm LPA and LPM and co-Administrator observed the door leading to the garage to be unlocked. Garage entry has 3 steps leading down to garage area that could potentially pose a fall risk for residents. Co-Administrator agrees to change garage door handle to include a handle with a lock. continued from 809C... LPA and Licensee discussed facility's Infection Control Plan. Licensee will send copy of Infection Control Plan to CCL within 30 days. 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 Infection Control Plan Evidence of Liability Insurance Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given.