Routine inspection (multi-day)·December 12, 2023

Licensing Program Analyst(LPA) Alviso conducted Required-1 Year inspection and met with live-in caregivers Melanie and Russel Taningco. Administrator Josephine Blancaflor was contacted by staff to notify them of LPA's arrival to the facility. There are six (6) residents in care. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden approval (room #1 only). Facility has an approved dementia plan of operation. Hospice waiver approved for one (1) resident. Facility has a required infection control plan. Facility has a required emergency and disaster plan. The LPA reviewed six (6) resident files. All files were complete. The LPA reviewed three (3) staff files. All staff have criminal record clearance as required. All staff have training. There was a sufficient supply of food, hygiene products, cleaners, and paper products. All auditory alarms were working as required. Based on LPA's review of facility records, and staff interviews, there have been no emergency drills conducted as required, quarterly drills; One of the quarterly drills must be a facility evacuation drill. The last drill per record review was in 2019. This deficiency will be cited. H&S Code 1569.695(c)- A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill, see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and Health and Safety Code. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights provided to staff Melanie Taningco for the Administrator. Exit interview conducted with staff Melanie Taningco.