Routine inspection·May 30, 2025

At approximately 12:00 PM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a Required 1 Year visit and was greeted by Administrator Victor Dada. Ashkalon House is Licensed as a Residential Care Facility for the Elderly (RCFE). The facility is a single story ranch house. The facility has an approved fire clearance for six (6) non-ambulatory residents and a Hospice Waiver for two (2) residents. Upon arrival, LPA was informed that there were three (3) residents in care and two (2) staff members on-site. At approximately 12:10 PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 12:15 PM, LPA toured the facility with Administrator Dada. All exits were clear and unobstructed. The facility's two (2) fire extinguishers were last serviced and tagged in 6/2024. The facility was sufficiently lighted. LPA inspected three (3) resident bedrooms and found all to have sufficient lighting and furnishings as required per Title 22 Regulations. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Toxins were observed to be stored inaccessible to residents. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The facility is conducting fire and emergency drills bi-annually. No Disaster drill logs were observed to be kept at the facility. Per Health Safety Code regulations, the facility should be conducting Disaster drills quarterly. This deficiency will be cited. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for all sinks in facility were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility smoke detectors and carbon monoxide detectors were tested and observed to be operational. Continued on 809-C... ...Continued from 809 At approximately 1:00 PM, LPA reviewed three (3) resident files. Three (3) of three (3) resident files were observed to be missing their 613-C Personal Rights Documents. This deficiency will be cited. LPA reviewed two (2) staff files. Two (2) of two (2) staff files were observed to not have current First Aid and CPR certification. This deficiency will be cited. LPA spot checked Medication for two (2) residents. LPA observed all medications to be centrally stored, secure and with proper documentation. The facility does not handle resident’s monies for personal and incidental items. Victor Dada’s Administrator Certification 700054740 is current with an expiration date of 3/31/2026. LPA requested the following documents be submitted to Community Care Licensing by 6/27/2025: LIC 500 Personnel Report LIC 308 Designation of Responsibility LIC 610E Emergency Disaster Plan Proof of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809Ds, Plan of Corrections, LIC 9102s, 811 Confidential Names and Appeal Rights discussed and provided to Administrator Dada. Signature on form confirms receipt of documents.