Routine inspection·January 15, 2025

Licensing Program Analyst (LPA) Alviso conducted a Required- 1 Year visit, on 1/15/25 at approximately 10:00am, and met with Licensee/Administrator Claudia Quijada. There are currently five (5) residents in care, and one (1) resident is on hospice services. Facility has an approved dementia plan of operation. There is an approved hospice waiver for two (2) residents. Facility has an infection control plan as required. Facility has an emergency disaster plan as required. Facility has a fire clearance approval for a total of six non-ambulatory, of which two (2) may be bedridden. All locks on exterior gates are approved. The self latching fire exit gate is never to have a lock on it. The facility's last fire drill and evacuation drill was conducted 10/15/24 & 7/1/24. The facility does have emergency food, water, and miscellaneous supplies to meet the "72 hour shelter in place" requirements. LPA reviewed five (5) resident files; Resident files were complete. LPA reviewed five (5) staff files. LPA reviewed staff training. All five(5) staff have criminal record clearance, and are associated as required. All staff had required training. All staff had current First Aid and CPR Certification. Hot water checked at 116.6 degrees Fahrenheit, which is within regulation. All exits were free and clear of obstruction. Fire extinguisher was serviced and tagged as required. Smoke alarms that are also carbon monoxide detectors were working properly during the inspection. The backyard has outside cement patio, with furnishings for resident use, including areas providing shade for residents as needed. The facility was at a comfortable temperature for residents in care; Residents were observed to be watching television and engaging with the staff during the inspection. Continued on LIC809C... LPA observed sufficient supply of food, perishable and non-perishable, for resident meals/snacks. Facility had sufficient furnishings for residents in care. The facility has sufficient lighting in all rooms, bathrooms, and common areas, including night lights. There was a sufficient supply of hygiene products, cleaning supplies, personal protective equipment (PPE), and paper products for use as needed. All bathrooms had grab bars, and non-slip mat/flooring for bathing/showering as needed. All medications were stored/locked and inaccessible to residents in care. All cleaners/disinfectants were locked up and inaccessible to residents in care. LPA is requesting the following documents be updated and submitted by 2/15/2025: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E- Emergency Disaster Plan (ensure to review and update as needed/required) LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Copy of Current Liability Insurance Copy of current Administrator Certificate The following deficiency was observed by the LPA during the inspection: Per file reviews and interviews, the Licensee has not submitted required incident reports/death reports; There is no proof that these reports were submitted to the licensing office, per file reviews. This deficiency will be cited, 87211-Reporting Requirements(a)(1)(2)-Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D). This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case, see LIC809D. Continued on LIC809C.. LPA observed numerous items stored in the food pantry that were open and not stored appropriately to ensure no contamination of the food items, observed were bags of flour, rice, crackers, chocolate mix, and other miscellaneous items. LPA discussed Food Service regulation with the Administrator in regards to storage of food items. This deficiency will be cited, General Food Service Requirements 87555(b)(28)- All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery, 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. Appeal rights given to the Administrator/Licensee. Exit interview conducted with Administrator/Licensee Claudia Quijada.