Routine inspection·October 9, 2023

On 10/09/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA was greeted by staff member, Antoinette Garcia, and explained the purpose of the visit. LPA Pascua asked that SM Garcia call the Facility Designated Administrator, Margaret Feril, to inform them that CCL was present. It was learned at this time that FDA Feril was unable to come to the facility at this time. Shortly after, LPA met with Facility Designated Representative, Ralph Feril and explained the purpose of this visit. There were no other staff members present at this time. Current census was 6. A brief interview with FDR Feril was conducted. This facility is licensed to serve 6 residents, 5 of which are ambulatory and 1 non-ambulatory. This facility has a dementia plan on file and has a hospice waiver for 3. It was learned that only the administrator and the representative have access to the facility files. LPA explained that facility records must be made available at all times to CCL staff. LPA reviewed 3 resident files and 3 staff files. Administrator has a current administrator certificate #6054358740 and expires on 12/05/2023. A medication cabinet was identified in the kitchen. Along with the FDR Feril, LPA observed, reviewed, and compared medication to medication dispensing logs. First Aid Kit was present and contained all of the required components. Fire Extinguisher was in compliance and has been services by Hayden Fire Protection on 07/13/2023. 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 non-perishable food supplies were identified. All cleaning supplies were locked and made inaccessible to residents at this time. 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 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Code. Appeal rights were printed and a copy was given to the facility . Exit Interview.