Routine inspection·May 4, 2023

On 05/04/02023 at 10:30am, Licensing Program Analyst (LPA) Arielle Pascua arrived to this facility unannounced to conduct an annual visit. LPA was greeted by Facility Designated Representative (FDR), Sarena Arias and explained the purpose of the visit. LPA asked the FDR Arias call the Facility Designated Administrator to inform them that CCL was present at this time. This facility is licensed to served 6 residents, all of whom may be non-ambulatory. This facility also has a dementia plan on file and has a current hospice waiver for 6. Current census was 3. 2 out of 3 residents were out of the facility at the time of the visit. LPA reviewed 3 resident files. LPA reviewed 4 staff files. 4 out of 4 staff files were complete and up to date. Facility Designated Administrator currently holds an active and current administrator certificate #6019506740 and expires on 08/16/2024. LPA initiated a tour with FDA Arias. The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annually inspected by A.R.F. Fire Extinguisher Co and is valid until 08/26/2023.. The kitchen area was toured. LPA observed a suppy of 7 day non-perishable and 2-day perishable foods in the cabinets and refrigerator. Additional perishable food supplies were identified in the garage. LPA observed cleaning supplies under the kitchen counter and was not locked and made inaccessible to the residents in care. LPA reminded FDR Arias that all toxins and cleaning supplies need to be locked and made inaccessible. LPA observed a locked centralized stored medication cabinet located in the laundry room. Along with the FDR, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components. LPA observed a large red bottle of pain medication that did not have a prescription order on it. After an interview with FDR Arias was conducted it was learned that the pain medication was given by a family member. LPA informed FDR Arias that all medication needed to have a prescription order along with a label with the resident's name. Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time. A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time. Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. A tour of the garage was conducted. Additional perishable food supplies were identified. The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair. The following forms and documents were requested to be updated and submitted into CCL -LIC 308 -LIC 400 -LIC 500 -LIC 610 -Liability Insurance Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited today in violation of California Code of Regulations. An Exit interview was conducted, a copy of the 809, 809-C, 809-D and appeals rights were provided to the facility at the end of this visit.