Routine inspection·August 13, 2024

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 9:00 A.M. The LPA was greeted by Caregiver Charlin Sitompul and informed the reason for the visit. Caregiver contacted the Administrator by phone, Shila Pandey. At 9:50 A.M. Administrator arrived at the facility, LPA explained the reason for the visit. Entrance interview conducted. Beginning at 10:25 A.M., the LPA along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Combination smoke and Carbon Monoxide detector was tested at 11:14 A.M. and was functional at the time of the visit. LPA observed one (1) fully charged fire extinguisher purchased on 03/21/2023. Administrator will buy a replacement and send proof to LPA. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 7 (seven) total bedrooms; 1 (one) of which is designated as a staff room and 6 (six) are private resident rooms. Staff room was observed locked. No client bedroom will be used as a public or general passageway to another room, bath, or toilet. There were no visible hazards or discrepancies observed. LPA observed that facility is not using appropriate waste receptacle with a tight-fitted cover. RESTROOMS: The LPA observed 3 (three) restrooms in the facility; 2 (two) are shared restrooms and one is a private restroom. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperatures were measured in all client bathrooms and measured within the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit at the time of the visit. Continues on LIC 809-C Continued from LIC 809 COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. A fireplace was observed to be adequately screened and inaccessible to residents. Auditorial signal was observed in each door around the facility. The facility maintained a comfortable temperature of 72 degrees Fahrenheit. Facility has a fire door to contain a fire from one side of the house to the other side. At the time and during the visit fire door was always open. OUTDOOR SPACE: The backyard has a shaded seating area for resident use. There were no bodies of water noted. The garage is attached to the house and locked at all times. Garage contained the laundry area, extra food, and additional storage. Washer, dryer, cleaning supplies and chemicals are stored and inaccessible to residents. Emergency water is stored in the garage. The LPA did not observe any obstructions to emergency exit pathways. KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food, as well as emergency food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. At 11:15 A.M., hot water temperature measured 109.4 degrees Fahrenheit. RECORD REVIEW: Record review began at 11:45 A.M., records were reviewed for but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. All 5 (five) resident records reviewed were missing needs and service appraisal, also, 2 (two) resident’s TB test results were not on their medical assessment. Licensee was not able to provide test result during the visit. 3 (three) staff files and administrator file were reviewed; all 4 (four) staff files reviewed were complete. Last Emergency Drill was conducted on 06/27/2024. Continued from LIC 809 Continued from LIC 809 MEDICATION REVIEW: Medications were observed locked in a cabinet across from the kitchen. Review began at 2:30 P.M. Medications for 5 (five) residents were observed. All 5 (five) residents' medications were observed to be maintained and administered in compliance with regulation. Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). One (1) civil penalties was issued, totaling $500. Exit interview conducted. A copy of the report and appeal rights were provided.