Routine inspection·September 5, 2024

Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual visit at 10:15 a.m. When the LPA arrived, there was one staff and four residents present. The LPA was greeted by a caregiver staff 1 (S1) and informed them of the reason for the visit. Back-up Administrator Mae Davis arrived shortly after S1 called. The back-up administrator works at the licensee's other facilities. At 10:18 a.m. LPA conducted a tour of the facility and conducted interviews during the physical plant tour. The facility is a single-story residence that consists of four (4) resident bedrooms and two (2) bathrooms. There is one (1) additional bedroom for staff use. The fire extinguisher was last serviced on 9/15/2023 and appeared fully charged. The smoke and carbon monoxide detectors were tested and functioned properly. LPA observed required postings near the entry. 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; Sharp objects are stored in a locked drawer to the right of the stove and cleaning supplies are stored in a locked cabinet under the sink. LPA observed the cabinet storing cleaning supplies was unlocked and unsupervised. Bedrooms: The resident bedrooms were properly furnished with adequate lighting, and clean bedding. Bathrooms: The LPA observed one private resident bathroom, one bathroom used by staff, and one bathroom used by the three other residents. All bathrooms were clean, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats. Residents have sufficient amounts of supplies for personal hygiene. The hot water was measured at 112.5*F in the private bathroom and 114.9*F in the other resident bathroom which is within the required limit of 105-120 degrees Fahrenheit. LPA observed in the staff bathroom there were cleaning supplies such as bleach stored in an unlocked cabinet under the sink. (continued on LIC809-C (continued from LIC809) 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. The facility maintained a comfortable temperature of approximately 72 degrees. Garage: The garage is where additional non-perishable emergency food items are held. Cleaning supplies and disinfectants are kept in the garage. The garage is locked and inaccessible to the residents in care. Laundry Room: The laundry room cabinets were observed to be unlocked with the laundry detergent accessible. Surrounding Grounds (Outdoors) : There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. File review: LPA reviewed administrator and staff files which were complete, including training. The administrator was off-site during LPA's visit but sent LPA documents that were requested by text and email during the visit. S1 is a new caregiver at this facility. S1 was not fingerprint cleared or associated to this facility; nor did S1 have a health screening on file. S1 stated they work as a private in-home caregiver and had fingerprint clearance but it did not show up in the CCL system. S1 stated this is their fourth day working at the facility. The back-up administrator called for another staff to relieve S1 until S1 can get cleared and associated to this facility. LPA reviewed all four residents' files which were complete. The LPA reviewed the facility's Infection Control Plan, Disaster Plan and evacuation drills. I nterviews: LPA conducted interviews with two residents and one staff. No immediate concerns were voiced during the visit. Medication audit: Medications were reviewed. Medications are centrally stored and locked in a cabinet in the common area; medications are labeled and checked for expiration dates. The Centrally Stored Medication and Destruction Records were completed. Medications appeared to be given as prescribed. 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.