Routine inspection·January 24, 2024

Licensing Program Analyst (LPA) Hansen conducted an unannounced annual inspection of this facility and met with Licensee, Darwin Galicia. Facility has 5 residents, none with dementia or under hospice care. Facility tour began : 01/24/2024 at 9:00am with staff Imelda & licensee/administrator Darwin Galicia, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. All notices that are required to be posted have been posted and are in a highly visible areas. Sample tour of resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Facility has at least two days of perishable and one week of non-perishable food. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Hot water temperature measured between 120.3. degrees F and 121. degrees F in 2 out of 2 resident’s bathroom faucets falling out of Title 22 acceptable regulation of 105 to 120 degrees F , licensee adjusted water heater during visit. Facilities two bathrooms were equipped with non-slip floor mats for safety. There was a supply of cleaners, hygiene products and paper products available for residents. Resident’s bedrooms have lighting & appropriate furnishings. Fire Extinguishers were found to be last charged on 01/11/2024. Smoke Detector and Carbon Monoxide Detector were tested and operational. Toxins are stored in a locked hallway closet & cabinet under sink. Facility maintains a 30-day supply of medication. Facility has no required log of disaster drills conducted which are to be conducted quarterly, in different shifts (see LIC809D). At approximately 10:30AM, LPA reviewed 5 of 5 resident records and found 5 of 5 residents did not have current Pre-Admissions Appraisals on file and 2 of 2 residents needing Re-Appraisals, Licensee did not have on file. (see LIC 809-D) Continue on LIC809-C Physician’s reports (602’s) were current for all residents. 5 of 5 resident records contained current and signed admission agreements on file. Medication records are thorough and contained physician’s orders for each resident. At approximately 12:15 PM, LPA reviewed 4 of 4 staff records, 4 of 4 records did not contain documentation of completed training records as required (see LIC809-D). Evidence of first aid and CPR training were current. All staff either had Covid-19 vaccination documents or exemptions on file. LPA interviewed 2 staff during this inspection. At approximately 1:30PM, LPA reviewed the facility emergency disaster plan with Licensee. Facility is working on getting a generator to supply power during an outage. LPA Hansen reviewed Licensing Information System (LIS) with Licensee who informed all is current. LPA advised facility to contact Local County Public Health and DSS/CCL Community Care Licensing if more than 3 COVID-19 + in the facility. Administrator Certificate is for Darwin Galicia # 6002465740 Exp. 6/1/2025. The following deficiencies were observed (see LIC 809D) and 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 and appeal of rights provided. Appeal of Rights Given. LPA Hansen is requesting Licensee to update and submit the following documents to CCL by 2/9/2024 LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Updated facility sketch showing exit door in rm 5 Copy of Administrator Certificate Copy of Certificate of Liability Insurance