Routine inspection·July 20, 2023

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and was greeted by Administrative Assistant, Charito Santos. Licensee Angelita Aquino and Administrator Nicanor Aquino arrived later. Required postings were observed. LPA initiated a tour of the facility around 8:45am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Residents room were furnished per regulation. Water temperature in bathroom used by residents measured 114.1, 113.5, 111.4 and 119.8 degrees F which is within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cleaning supplies are stored in the locked laundry room. Facility has at least two days of perishable and one week of non-perishable foods. Facility has emergency food and water supplies. Fire extinguisher was last serviced June 2023. Smoke detectors located throughout the facility as well as the Carbon Monoxide detector were tested and operational during inspection. Knives are located in a locked drawer in the kitchen. Kitchen staff were in kitchen at the time of inspection and LPA confirmed that the kitchen was locked when staff were not in the kitchen. Exit doors have auditory alert system that were functional at time of visit. All fees are current as of this time. Reviewed current Contact Information. Administrator Certificate for Nicanor Aquino 6010494740 expired, but there was proof that it is listed on the Department's pending Administrator Certificate list. Last emergency disaster drill conducted in May 2023. At approximate 9:00am LPA/staff observed one out of four bathrooms used by residents located in wing "A" had a urine smell, ceiling in the bathtub area was peeling off, the bathtub was dirty and unsanitary including curtain that needs to be replaced. Continued on LIC809C... Continued from LIC809... At approximate 10:00am LPA/staff conducted file review. Ten residents and six staff files were reviewed. All ten residents appraisals/needs and services plans and medical assessments were current. Staff have required First aid and CPR certificates. However, three out of six staff (S1, S2 & S3) have not met the training additional 20 hours requirement. At approximate 11:00am LPA/staff conducted a spot check of medications and it was revealed during medications review that 10 out of 10 resident's (R1, R2, R3, R4, R5, R6, R7, R8, R9 & R10) medication log were not entered into the Centrally Stored Medication Log within the last 12 months. Also, six out of ten (R1, R2, R3, R4, R5 & R6) resident's medications for the evening had already been poured. LPA instructed staff that pre-pouring medication was not allowed and medication must stay in it's original container. Medications were centrally stored and locked in a medication cart located in the office. Licensee/Administrator to submit updates of the following documents by 8/1/2023: -LIC 500 Personnel Summary -LIC308 Designation of Facility Responsibility. -Copy of Liability Insurance -LIC 610 Emergency Disaster Plan (If changes) -Infection Control Plan (If changes) Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. 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.