Routine inspection (multi-day)·December 4, 2024

Licensing Program Analyst (LPA) Alviso conducted continued annual inspection and met with live-in caregiver Melanie Taningco. LPA observed a second caregiver, Jennie, working in the facility upon arrival. Administrator Josephine Blancaflor was contacted, and arrived within the hour to meet with the LPA. There were six (6) residents in care during the LPA's inspection. 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 a required infection control plan. Facility has a required emergency disaster plan. LPA reviewed facility records. Emergency Disaster drill are conducted as required, quarterly drills with one being an evacuation drill. Last drills conducted with facility staff were held on 9/30 and 6/29, 2024. LPA observed all utilities were working appropriately and available for use as required for facility operations. Fire extinguishers (2) were serviced and tagged as required. All exits were clear and unobstructed. Facility was clean and orderly. Food supply was sufficient with both perishable and non-perishable foods; LPA observed lots of fruit on the kitchen counter which is used for residents meals and snacks. Resident rooms, bathrooms, hallways, and common areas had sufficient lighting for residents in care. All disinfectants and cleaners were locked and inaccessible to residents in care. All medications were locked and inaccessible to residents in care. The facility was at a comfortable temperature. There was a sufficient supply of hygiene products, linens, cleaners/disinfectants, personal protective equipment (PPE), and paper products. LPA reviewed six (6) resident files, including a review of resident medications/logs. Continued on LIC809C... LPA reviewed four (4) staff files, including staff required training. LPA is requesting the following documents be updated and submitted by 1/4/2025: 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 deficiencies which will be cited today: LPA observed the backyard fire exit gate to be broken, a bit slanted down, large and heavy, and not able to open freely as needed during an emergency. LPA obtained photos. The Administrator stated they have an estimate to have the gate and it's side fencing redone and balanced as needed, so the fire exit gate works appropriately. This deficiency will be cited, 87203 Fire Safety- All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic, 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. Appeal rights provided to the Administrator. Exit interview conducted with Licensee/Administrator Josephine Blancaflor.