Facility is licensed to serve six (6) non-ambulatory residents over 60. In which one (1) may be bedridden. It is approved for a hospice waiver for three (3).

The facility is part of a two story apartment located in a residential area and contains the following: living room, dining room, kitchen with refrigerator, electric oven, dishwasher, sink/faucet, locked storage cabinet for medications, (3) resident rooms, (1) bathroom; bathroom with shower, toilet and washbasin, room #1 contains a private closet, washer and dryer. A front yard and a backyard with shaded/furnished area for resident use. The residence is equipped with central air and heating.

Staff and Administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

Resident bedrooms had furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises.

Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 119F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked.

Continue to LIC 809-C.

Knives and toxics were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher was observed in the living room. Administrator tested all carbon monoxide detectors and smoke detector located near residents’ room. Both devices were functional.

5 staff records were reviewed. Two staff interviews were conducted.

5 resident records were reviewed and, 5 out of 5 client records had Medical Assessments. Two residents’ medication was reviewed. Two residents were interviewed.

Deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809D.

During record review, on two occasions, LPA observed vermin on the dining table and in the resident's file. LPA also observed dead vermin near the baseboard in the dining room. LPA and Administrator observed vermin on dining ceiling. The Administrator immediately spoke with the landlord to establish pest control services.

During record review, LPA did not see an eligible Guardian clearance for staff #3 hired 12/04/2023. S3 is only cleared at the licensee's other facility. S3 was not on-site. At 12:54 PM, the House Manager notified LPA that the deficiency was corrected. LPA verified that the deficiency had been resolved.

An exit interview was conducted, technical assistance provided, Plans of Corrections were developed and reviewed. A copy of this report and appeal rights were discussed with the House Manager and left with Staff Djie Lan Nio.