Routine inspection·January 23, 2025

Licensing Program Analyst (LPA) Alviso arrived unannounced to conduct a Required -1 Year inspection, on 1/23/25 at approximately 9:20am, and met with Sarah Araya, Administrator. LPA observed two caregivers on duty during the inspection. Currently there are four (4) clients in care. The facility has a fire clearance for six (6) non-ambulatory residents. Facility has a required infection control plan, and a required emergency disaster plan. Hospice waiver approval is for two (2) residents. Per record review, facility is holding quarterly emergency disaster drills as required. Fire extinguisher was serviced and tagged as required. LPA reviewed four (4) resident files. Medications, and medication records were reviewed. LPA reviewed four (4) staff files, including training. LPA toured the facility with the Administrator. Hot water was checked at 110.4 degrees Fahrenheit, which is within regulation. LPA observed sufficient food supply. LPA observed sufficient supply of paper products, cleaners/disinfectants, hygiene products, and personal protective equipment (PPE). Facility had sufficient lighting in resident rooms, common areas, bathrooms, and hallways for resident use. Bathrooms had required grab bars, and non-slip flooring/mats in showers/bathtubs for resident use. Medications are stored in a closet that is locked, making medications inaccessible to residents in care. Cleaners/disinfectants are kept locked and inaccessible to residents in care. LPA discussed regulation regarding fire clearance and ensuring all fire exits are fully cleared/unobstructed at all times as required. Administrator stated their understanding. Administrator had staff move the table from blocking part of the slider door exit during the inspection. Continued on LIC809C.. Continued from LIC809.. LPA is requesting the following documents by 2/23/25. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed/required) Infection Control Plan (ensure to review and update as needed/required) Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate . LPA observed the following deficiency:: LPA observed a made-up rollaway bed in an open storage room in the facility's back room/ common area. S1 told the LPA that the bed was staffs. The staff that come in and work nights use the bed, it is brought out into the common area. LPA discussed regulation regarding facility bedrooms, common areas, and awake night staff versus sleeping night staff. This deficiency will be cited, 87307(a) Personal Accommodations and Services- Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility, see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator Sarah Araya Appeal Rights provided to the Administrator.