Routine inspection·August 13, 2024

Licensing Program Analyst (LPA), Alviso is conducting an Required-1 Year inspection, on 8/13/24 at approximately 1:00pm, and met with Administrator Leonardo Dela Cruz. LPA observed two caregivers, Rolando and Josephine, on duty. The facility's nurse arrived during the LPA's inspection. Currently three (3) residents in care. Facility has an approved fire clearance for three (3) non-ambulatory residents. All resident rooms are private. The facility does have a required infection control plan. The facility does have a required emergency disaster plan. Facility had a fire drill on 6/10/24 and an earthquake drill on 6/21/24, per record review. LPA reviewed three (3) resident files. Files were complete. P&I monies were intact, not stored with any other facility funds/not commingled. All records of P&I were complete and maintained accurately. LPA reviewed five staff files. All staff have first aid and CPR as required. All staff have criminal record clearance as required. Staff have required training. Facility had a sufficient food supply. Medications were locked up and inaccessible to residents in care. Sufficient cleaners/disinfectants, paper products, hygiene products, and linens. Cleaners/disinfectants were locked up and inaccessible to residents in care. Facility had a sufficient supply of furnishings for resident use. All resident rooms, bathrooms, hallways, and common areas had sufficient lighting for resident use. The facility was observed to be at a comfortable temperature; Facility does have a heater system, and air conditioner unit for use as needed. There were emergency supplies, including food and water. The fire extinguishers were fully charged,two (2) in the facility. All exits and walkways were clear of obstruction. Sufficient personal protective equipment (PPE) supply for use as needed. The backyard was clean and orderly, and had patio furnishings, and shade cover for resident use. Continued on LIC809C... LPA is requesting the following documents be updated and submitted by 9/13/24. LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to review and update as needed and/or required) Infection Control Plan (ensure to review and update as needed and/or required) Copy of LIC400 Handling of Client Cash Resources (must complete, include copy of surety bond if handling cash) Copy of Current Liability Insurance Resident Roster Copy of current Administrator Certificate . The following deficiency was observed and will be cited, see LIC809D. Hot water was checked at 134.9 degrees Fahrenheit which is not in compliance with regulation, hot water to be no higher than 120. degrees Fahrenheit and no lower than 105. degrees Fahrenheit. Administrator turned down the water heater during the inspection. Deficiency citation, 87303(e)(2) Maintenance and Operation- Water supplies and plumbing fixtures shall be maintained as follows: Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C), 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. Appeal Rights provided to the Administrator.