LPAs Gutierrez and Tea along with Staff Arphie Tanedo and Administrator Priscilla Celis toured the facility at 8:14 AM. LPAs toured the physical plant, checked food service, and the first aid kit. The home consists of four resident bedrooms, one shared hall bathroom and another one in a shared resident room, a living room, dining room, and kitchen on the first floor and two staff bedrooms and a bathroom on the second floor for staff. There are no residents residing on the second floor. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident. Toilets and water faucets were operational, grab bars were secure and shower was free of mold/mildew. Water temperature measured at 119.3 degrees F in all facility bathrooms. LPAs observed an extra supply of resident bath towels, toiletries and personal hygiene supplies during today's visit. Common areas were clear of hazards, doorways were free of obstructions. First aid kit had all the required elements. LPAs observed a locked storage area for cleaning supplies under the bathroom sink. Facility has a two day supply of perishable and a seven day supply of non-perishable food as required by regulation. LPAs observed sharps locked in a kitchen drawer. Smoke detectors and Carbon Monoxide detectors tested operational during today's visit. Fire extinguisher was observed to be fully charged with service tag dated September 6, 2023. Kitchen appliances were observed to be operational. LPAs toured the backyard and observed the backyard fence to be leaning towards the neighbors' house causing a tear in the middle leaving a gap in the fence and between the two properties. (Cont. LIC809-C)

At 8:45 AM, LPAs reviewed five resident files and four staff files. Resident files contained required documents including admission agreements, current physician reports, resident appraisals and physician orders for bed rails as indicated. Staff files reviewed contained required documentation of annual training, health screen/TB, and criminal record clearance. At 8:24 AM, LPAs reviewed medication storage and administration. Centrally stored medications were observed to be stored in a locked cabinet, however, unsecured medication was observed on the kitchen table and in a resident's bathroom: a deficiency was cited on today's date.

Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with AD Priscilla Celis and a copy of this report, LIC809-D, and Appeal Rights was provided at the end of the inspection.