Routine inspection·August 8, 2023

Licensing Program Analysts (LPAs) Christi Coppo and Marisol Cuadra arrived unannounced to conduct an Annual required inspection and was greeted by individual (I1). Licensee Ami Kumar arrived later. LPAs observed I1 was providing care to residents at the facility at the time of visit. LPA informed Licensee that I1 is not associated to facility and should never be working and providing care to residents prior to a criminal record clearance or exemption. ***Civil penalties are being assessed in the amount of $100 per day for allowing a person to work, reside or volunteer in the facility without a fingerprint clearance/transfer per two weeks for a total of $500. LPAs/staff initiated a tour of the facility around 9:00am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Residents rooms were furnished per regulation. Extra hygiene products and linens were available. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Two fire extinguisher was last serviced April 2023. Smoke alarms are hard wired with sprinklers and fire doors on each resident room as well as a fire door in the hallway. Smoke alarms and carbon monoxide detector was tested and operational at time of inspection. Last Disaster drill was conducted on 7/10/23. Working auditory alarms are placed on all exits. Disinfectants and cleaning solutions were stored inaccessible to residents. Required postings were observed. Administrator Certificate for Ami Kumar, 6021684740, expires on 11/8/24. Medications were centrally stored and locked. Hot water temperature reading was 113.2 and 110.4 degrees which is within regulation. Continues on LIC809C... Continued from LIC809... LPA initiated file review at 9:30 am. LPA reviewed six residents files and five staff files. All residents files have a current medical assessment and care plans updated within the last 12 months. Staff records have current First Aid/CPR certificates and additional 20 hours of required training. At approximate 11:00am LPA/staff conducted a spot check of medication and found resident's (R1 & R2) medications were not current into the Centrally Stored Medication. Licensee agreed to review and update the Centrally Stored Medication Records. Licensee agreed to submit updates of the following documents by 8/22/23: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and Copy of Liability Insurance. 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 Licensee and a copy of this report was provided.