Routine inspection·August 9, 2023

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at 12:00 p.m. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Paul Oyasan arrived shortly thereafter. The LPA and the Administrator began the tour of 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. KITCHEN: The LPA began the inspection in the kitchen/food service area at 12:15 p.m. Knives and cleaning supplies stored under the kitchen sink were observed to be accessible at the time of visit. Staff was unable to lock the cabinet as the lock was broken. The LPA additionally observed a bag on a chair at the dining room table that contained accessible over the counter vitamins and supplements. It was indicated by the administrator that it belonged to staff. LPA advised the administrator that any over the counter medications, supplements and vitamins do need to remain locked and inaccessible to residents in care. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Hot water temperature in the kitchen measured at 117.5 degrees F at 12:29 p.m. The facility has an attached garage that is accessible through the kitchen, the garage contains a staff break area, facility office, additional refrigerator with perishable foods, additional nonperishable food supply,cleaning supplies, emergency water and food supply and laundry appliances. The garage was locked at the time of the visit. COMMON AREAS: Living room and dining room furniture were observed to be in good condition. There is a fireplace in the living room, which is covered with a screen and inaccessible. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested at 12:45 p.m. and operational at the time of the visit. The fire extinguisher located in the kitchen was fully charged and last serviced September 1, 2022. The LPA observed required postings throughout the common space. Continued on LIC 809-C PAGE 2 BEDROOMS/BATHROOMS: The LPA inspected the bedroom and bathroom areas. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are four designated resident rooms one shared and three private bedrooms. There was a linen closet in the hallway with extra towels and linens. There are two resident bathrooms, the resident bathroom in the hallway was observed to be in need of cleaning as toilet bowl was soiled and toilet paper holder was broken. Bathrooms were observed to have grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured in the hallway bathroom at 115.8 degrees Fahrenheit. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single latched. No bodies of water noted and exit is free of obstructions. RECORDS: Personnel records were observed to be incomplete, not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. The following was noted: 2 out of 4 staff records (S1, S2) were missing and unavailable. 2 out of 4 staff records (S3, S4) were incomplete at the time of record review. LPA was unable to verify required training hours for 4 out of 4 staff (S1, S2, S3, S4). 3 out 4 staff were not associated to the facility (S1, S2, S3). Civil penalties assessed. Due to time constraints, the LPA will return at a later date to complete the inspection. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.