Routine inspection·January 19, 2024

At 09:00 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Karina Rosales Antig arrived shortly. At 9:40 a.m. the LPA conducted a tour of the physical plant with the Administrator to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of five (5) resident bedrooms, one (1) staff room, and two (2) restrooms. The LPA observed one (1) fire extinguisher which was fully charged and last purchased on 05/18/2023. All smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings in the hallway near the entrance area. Kitchen : The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility. Food is prepared based on the menu. Snacks and beverages are always available for the residents. At 9:41 a.m. the LPA observed two knives in the unlocked dish washer machine. At 9:43 a.m. the LPA observed Robitussin cough+sore throat medication, Greri Tussin DM medication, and Nystatin 100,000 unit/ml medication in the kitchen refrigerator accessible to residents in care. Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding. At 10:01 a.m. the LPA did not observed a required “No Smoking-Oxygen in use” sign in room #2 due to use of oxygen equipment. Report will continue on LIC809-C. Bathrooms: The LPA observed all bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. At 10:14 a.m. water temperature in resident’s restroom was measured at 116.3 degrees Fahrenheit. The hot water measured was within the required limit of 105-120 degrees Fahrenheit. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in the living room, which is covered with a screen. There were no obstructions and/or tripping hazards throughout the facility. The garage: The LPA observed the garage where additional supplies and the emergency food and water is stored. Cleaning supplies and disinfectants are kept in the garage. The garage is locked. Surrounding Grounds (Outdoors) : The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water on the premises. The LPA observed paint buckets, nails, and equipment in the backyard. Upon observation the administrator stated maintenance will be picking up all items today. Record Review: At 11:13 a.m. a review of facility files was initiated. The LPA reviewed five (5) out of five (5) resident files. The following was observed: Two out five residents (R1, R2) did not have a pre-placement appraisal (LIC 603), or appraisal/needs and services plan (LIC625). Three out of five Residents (R3,R4,R5) did not have a required annually updated LIC625. At 10:20 a.m., the LPA observed R5 residing in room five (5), which is not an identified bedridden room. Per R5’s physician’s report, R5 is identified as bedridden. Per the fire clearance, the facility does not have a bedridden fire clearance at this time. Administrator could not verify if they a bedridden fire clearance. An immediate civil penalty of $500 is assessed, due to a violation of the fire clearance. The LPA obtained a Client Roster and Staff Roster. I nterviews: The LPA conducted two (2) resident Interviews. No immediate concerns were voiced. Due to time constraints the LPA will return at a later date to complete the annual. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided to Administrator Karina Rosales Antig.