Routine inspection·February 6, 2025

At approximately 8:00 AM Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct an Annual Required Inspection and was greeted by a Caregiver. Administrator, Eufrasia "Oliva" Garcia arrived at 8:30 AM. Facility is a single story ranch house. Facility has an approved fire clearance for six (6) non-ambulatory residents with an approved Hospice waiver for three (3). Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Upon arrival, LPA was informed that there were six (6) clients in care and two (2) staff members on-site. At approximately 8:30 AM, 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 8:45 AM, LPA toured the facility with Administrator Garcia. All exits were clear and unobstructed. Fire extinguisher was last serviced and tagged on 12/5/2024. Food supply was sufficient. The facility was sufficiently lighted and Furnished. During the inspection, LPA observed that there was no Residential Care Facility for the Elderly (RCFE) complaint poster (PUB 475) posted in a conspicuous location as per Title 22 Regulations. A Technical Violation is being issued for the PUB 475 not being posted. LPA inspected three (3) client 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 clients. Toxins were observed to be stored inaccessible to clients. Facility has an infection control plan as required. The facility has a required emergency disaster plan. The last disaster drill was conducted on 12/1/2024. The facility does have emergency food and supplies to meet the "72 hour shelter in place" requirements. Hot water temperatures for four (4) sinks in facility were measured and three (3) of four (4) were observed to exceed Title 22 regulations of 105 to 120 degrees Fahrenheit. This deficiency will be cited. Facility smoke detectors and carbon monoxide detectors were tested and operational. Continued on 809... ...Continued from 809 At approximately 10:15 AM, LPA reviewed six (6) staff files. LPA observed that one (1) staff member (S1) did not have an LIC 503 Health Screening Report - Facility Personnel on File. In Addition, one (1) staff member (S2) did not have their LIC 503 signed by an authorized health care professional. These deficiencies will be cited. All staff members had current First Aid and CPR certification and proper training documentation. LPA reviewed five (5) resident files. LPA observed that one (1) resident's (R1) file did not have a 602A Physician's Report for Residential Care Facilities for the Elderly (RCFE) . This deficiency will be cited. Four (4) residents' files were observed to have all required documentation. LPA spot checked Medication for three (3) residents. LPA observed that three (3) of three (3) residents medications were not properly documented in the LIC 622 Centrally Stored Medication and Destruction Records per Title 22 Regulations. These deficiencies will be cited. The facility does not handle client monies for personal and incidental items. Administrator's Certificate renewal for Eufrasia Garcia (7017395740) was received by Community Care Licensing on 10/3/2024. LPA requested the following documents be submitted to Community Care Licensing by 3/6/2025: LIC 308 Designation of Responsibility LIC 610D Emergency Disaster Plan Proof of Liability Insurance 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. Copy of report, LIC809Ds (Deficiency Pages) with plans of corrections, LIC9102 Technical Violation, Confidential Names (LIC811), and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.