Routine inspection·January 8, 2024

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at 9:45 a.m. The LPA was greeted by staff, Administrator Karina Antig arrived shortly thereafter and informed them of the reason for the visit. The LPA and 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. COMMON AREAS : At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is blocked by a tv console and inaccessible. The facility maintained a comfortable temperature of 75 degrees. Smoke detector(s) and carbon monoxide detector were tested at 11:40 a.m. and operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last purchased May 18, 2023. The LPA observed required postings throughout the common space. The laundry is located in the hallway behind the kitchen. All laundry supplies are locked and inaccessible. KITCHEN: Kitchen/food service area was inspected at 10:25 a.m. Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: There are five designated resident rooms and one staff room. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Linens are kept in a hallway closet. BATHROOMS: The resident bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature in bathrooms measured between 127.0-131.0 degrees Fahrenheit. Continued on LIC 809-C OUTDOOR AREA: The backyard has an outdoor area equipped with furniture and shade for client use. There is a side gate for resident exit and is single latched. No bodies of water noted. The garage contains an additional refrigerator with perishable food items. Additional nonperishable food was observed along with emergency food and water. Cleaning supplies and disinfectants are kept in locked in the garage. RECORDS: Residents’ records review began at 12:55 p.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 12:05 p.m.; medications are centrally stored and locked in a cabinet in the kitchen above the microwave. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL : Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPAs obtained the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Liability Insurance 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 issued.