Routine inspection·May 8, 2023

Licensing Program Analyst (LPA) Victoria Bertozzi arrived unannounced to conduct an Annual Required inspection and was greeted by staff. Licensee/Administrator, Victor Dada arrived later. LPA initiated a tour of the facility around 1:20pm and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Residents rooms were furnished per regulation. Water temperature in bathroom used by residents measured at 118 degrees F which is within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cabinets containing cleaning supplies and knives were locked. 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. Medications were centrally stored and locked. Facility has emergency food and water supplies. Facility currently has a resident, R1 who is bedridden per their most recent medical assessment but facility does not have a fire clearance that allows for bedridden residents. Fire extinguisher was last serviced April 2023. Facility has hardwired combination Smoke/Carbon Monoxide detectors located throughout the facility that were tested and operational during inspection. Two staff files and three resident files were reviewed. Staff do not have required First Aid and CPR Certificates and have not completed annual training. Administrator Certificate for Administrator Victor Dada 6000794740 expires 3/31/2024 . Three of three residents do not have preadmission appraisals and two of three do not have a valid Admission Agreements. Medications and medication records were reviewed. Continued on LIC809C Continued from LIC809 LPA discussed the lease that will be expiring later this year. Licensee will discuss a new lease with the landlord and submit the updated lease to CCL once signed. Licensee/Administrator to submit updates of the following documents by 6/08/2023: LIC 500 Personnel Summary Copy of Liability Insurance LIC 610 Emergency Disaster Plan (If changes) Infection Control Plan (If changes) 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.