Routine inspection·February 27, 2024

Licensing Program Analyst (LPA) Alviso, conducted a Required 1 -Year Inspection, 2/27/24 at approximately 1:15pm, and met with Lead caregiver Rosie (Rosario) Achacon. LPA observed another caregiver, Fely Delapena, on duty. Caregiver Rosie contacted the Licensee/Administrator Sheila Sumabat to notify them of the LPA's arrival to the facility. Administrator Sheila arrived within 20 minutes of being contacted. There are five (5) residents in care. The facility has a required infection control plan. The facility has a required emergency & disaster plan. Facility has an approved dementia plan of operation. There is an approved hospice waiver for four (4) residents. Fire clearance is approved for six (6) non-ambulatory. Fire extinguisher is serviced and tagged as required, expires 8/17/24. Facility has smoke alarms as required, and a carbon monoxide detector as required. Per review of records, fire/emergency drills are held quarterly as required: Last drill conducted was a fire and evacuation drill, held on 1/2/24. The facility held a fire, and earthquake drill 10/20/23, and three other emergency drills in the year 2023. The LPA toured the facility with caregiver Rosie. Hot water was checked at 113.2 degrees Fahrenheit. Medications were locked up as required. Cleaners/toxins were locked up as required. All exits and walkways were clear, and unobstructed as required. LPA observed there was sufficient lighting in hallways, bathrooms, common areas, and resident rooms. Facility was observed to be at a comfortable temperature. Facility was observed to clean and orderly. Food supply was sufficient. Facility had emergency supplies stored to meet the "72 hours in place" requirement. `Continued on LIC809C... Facility had a sufficient supply of linens, and furnishings for resident use. There is an outside patio area, with table, umbrella, and chairs for resident use. All resident bathrooms had grab bars as required. Resident shower room has grab bars, and shower mat for resident use. The LPA reviewed five (5) resident files. All files were complete. LPA reviewed five (5) staff files. LPA reviewed staff training. All five(5) staff have criminal record clearance as required. All staff are associated as required. All staff had required annual training. All staff had current First Aid and CPR Certification. LPA is requesting the following documents be updated and submitted by 3/27/24: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan- review and submit (provide all information in all boxes as required) Infection Control Plan- review and submit (provide all information as required) Copy of LIC400 Handling of Client Cash Resources (complete the form even if not handling cash) Copy of required Surety Bond (if handling cash) Copy of Current required Liability Insurance Copy of current Administrator Certificate There were no deficiencies cited today.