Routine inspection·January 11, 2024

Licensing Program Analyst(LPA) Alviso arrived unannounced to conduct a Required -1 Year inspection and met with caregiver Marife Davis. There were two other caregivers at the facility, Robert White, and Estelita Cabardo. Robert contacted Administrator Eden Relota, and notified them the LPA was at the facility. The Administrator arrived to meet with the LPA. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. The facility has a required infection control plan. The facility has a required emergency and disaster plan. Per file review, last fire drill was completed on 12/5/23. Licensee is completing fire/evacuation/emergency drills quarterly as required. Fire clearance is approved for four (4) non-ambulatory, of which one(1) may be bedridden. There were four (4) residents in care at the facility; One (1) resident currently on hospice care. LPA reviewed four (4) resident files. All files were complete. LPA reviewed four (4) staff files. All staff have criminal record clearance as required. All staff have annual training. All staff have required First Aid & CPR certification. LPA toured the facility with the Administrator. All exits were unobstructed. Fire extinguisher was serviced and tagged as required- expires 5/9/24. Carbon monoxide detector was working properly during the inspection. All smoke alarms were working when checked during the inspection. All bathroom(s) had grab bars, and non-slip mat/flooring for bathing as needed. All postings were up and visible to all as required. Facility has a sufficient supply of personal protective equipment(PPE). Sufficient food supply, perishables and non-perishables. Continued on LIC809C... Cleaners/toxins were observed to be locked up and inaccessible to residents in care. Facility was at a comfortable temperature during the inspection. LPA observed the facility to be clean and orderly.LPA requested Licensee to update the following documents by 2/11/2024. LIC 308 Designated LIC 500 Personnel Summary-all staff names/titles-days/hours working LIC 610E Emergency Disaster Plan- update as needed-submit copy-if not updated-submit copy of review page signed/dated. Infection Control Plan- update as needed-submit copy-if not updated-submit copy of review page signed/dated. LIC 9020 Register of Facility Client’s/Resident’s. Copy of Administrator Certificate Copy of Certificate of Liability Insurance Copy of LIC400 Handling of Client Cash Resources, include copy of surety bond. if handling cash LPA observed the following deficiencies: LPA observed a plastic container in the refrigerator with medications unlocked , accessible to residents, and to any others in the facility that don't handle medications. Cited, Incidental Medical and Dental Care Services Section 87465(h)(2) - Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication, see LIC809D. The following deficiency(s) was/were cited from 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 the Administrator. Appeal Rights provided to the Licensee/Administrator.