Routine inspection·July 23, 2024

Licensing Program Analyst (LPA) Cuadra arrived unnanounced to conduct a Required Annual Inspection and met with Charito Santos (Administrative Assistant), Nicanor Aquino (Licensee) arrived later. Annual fees are current. Required postings were observed. LPA/Administrative Asst. initiated the tour at 9:00am and made the following observations: Facility was a comfortable temperature with thermostat reading at 76 degrees F. Passageways were free from obstructions. Resident rooms needs a chair per resident per regulation (technical violation will be issued). During the tour of the facility LPA/Administrative Asst. bserved water temperature in resident bathroom measured at 124.3, 126.7, 106.1 and 126.3 degrees F, which are not within allowable range of 105 to 120 degrees F. Staff adjusted water heater immediately (Technical violation will be issued). Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Cleaning supplies were also observed under the kitchen sink. Bathroom #2 windowsill have paint bubbles need to be cleaned; bathroom #1 sink needs to be cleaned; Resident's room (room # 10, 11, 13 and 17) window screens are missing. Face plate in room #10 needs to be replaced. Knives are located in a locked drawer in the kitchen. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked in a medication cart located in the office. Fire extinguisher was last inspected May 2024. Smoke and Carbon Monoxide detectors were tested during inspection and operational. Exit doors have auditory alert system that were functional at time of visit. Cash resources and records were reviewed. Emergency Disaster Drill has not been conducted within the last quarter. Medications and medication records were reviewed. Continued on LIC809C... Continued from LIC809... File review was initiated at 10:00 am. Five resident and four staff files were reviewed. Medical assessments, appraisals/needs and services plans are current. Staff have required First aid and CPR certificates. However, four out of four staff do not have required 20 hours additional training hours. Administrator Certificate for Nicanor Aquino 6010494740 expired October 7, 2023. Although, the licensee stated that they are taking required training hours. There is no supporting evidence that they have submitted any required documentation for the Department to review, LPA reached out to the administrator certification unit on 7/17/24 and they have not received a renewal/new application from any of the two licensees. The Department will be reviewing the information obtained to determine if further actions are needed. During today's visit, LPA is also following up on SOC341 along with an incident report submitted to the Department on 6/20/24 involving two residents (R1 & R2). Per incident report, on 6/18/24 around 7pm, staff was assisting R1 with medications when R1 complained that there were only four medications and one was missing. Staff clarified to R1 that there were five tablets, but R1 kept insisting that there were only four tablets. R1 became anger, confronted R2, who was sitting in front of R1 that they have the right to complaint to staff, then both residents started pushing and hitting each other until R1 spit on R2. Staff called 911 immediately, police arrived and talked to both of them (SR #241700309). Later, R1 found the missing tablet under their table, then R1 stated that they accidentally dropped the tablet and apologized for their behavior. Responsible parties were notified. According to staff no further incidents have happened. Licensee agreed to submit updates of the following by 8/13/2024: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), Copy of Liability Insurance and Surety bond. 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 was conducted with Administrative Assistant and a copy of this report was given.