Routine inspection (multi-day)·March 3, 2025

Licensing Program Analysts (LPAs) Alviso and Contreras conducted a continued annual inspection, on 3/3/25 at approximately 2:25pm, and met with Administrator Eden Relota. There are four clients in care. 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. 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. Two (2) fire extinguishers were serviced and tagged as required. All exits were clear and free of obstructions. All exits had auditory alarms on the doors; All alarms were working properly during the inspection. Facility has a carbon monoxide detector that was working properly during the inspection. LPA reviewed four (4) resident files, including medication storage and medication records. LPAs reviewed four (4) staff files. All staff have required, criminal record clearance, first aid certification, and CPR certification LPA is requesting the following documents be updated and submitted by 4/03/25. 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) Continued on LIC809C.... 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 . The following deficiencies were observed: Per LPA's file reviews staff, 2, 3, and 4 lacked required medication training. This deficiency will be cited, HSC 1569.69(a)(2) (2) Medication Training- In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment, see LIC809D Per LPA's file reviews staff, 2, 3, and 4 lacked required annual training. This deficiency will be cited, HSC 1569.625(b)(2) Annual Required Training-In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training, 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/Licensee Eden Relota. Appeal Rights provided to the Administrator.