Kitchen: The kitchen area was observed at 9:55 a.m. The facility has a sufficient supply of non-perishable and perishable food items. Cleaning supplies and disinfectants are stored inaccessible to clients. Knives are stored in a locked cabinet in the kitchen.

Common areas: Living and dining room furniture were observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. In the living room, the LPAs observed that four (4) out of ten (10) light bulbs were in disrepair and needed to be replaced. However, the Administrator noted that they would correct this. No deficiency issued at this time. At 2:15 p.m., smoke detector(s) and carbon monoxide detector were tested and were operational at the time of the visit. The LPAs observed required postings throughout the common space. The fire extinguishers were charged and were serviced 7/6/2022.

The backyard has a covered outdoor area equipped with furniture for client use. The side gate was self-closing and latched. No bodies of water noted. The washer and dryer are in the garage. There were additional perishable and non-perishable food items in the garage, which were in good condition at the time of the visit. The garage is not locked.

Restrooms: The two client restrooms 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. At 10:23 a.m., the hot water temperature measured in the hallway restroom at 112.1 degrees Fahrenheit.

Records: The LPAs reviewed client and staff records at 10:29 a.m. The LPAs reviewed five (5) client files for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, and current needs and services plan. All files were missing the LIC627(c) Consent for Treatment form. However, the Administrator communicated that the facility utilizes a similar form; yet it is in the process of being updated. The LPAs reviewed five (5) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, current first aid certification. All files were complete.

At the start of the visit, the LPAs noted that the Administrator on file was Amanda G. Lee. However, the licensee indicated that the current Administrator was Vanessa Garcia. The LPAs stated that they would request additional information to be sent via email to make the change of Administrator. Yet during today’s visit, the LPAs audited the current Administrator’s file and it was in order. The facility has one (1) facility van, which had appropriate vehicle insurance at the time of the visit. The facility is vendored by Tri-Counties Regional Center (TCRC) as a level 4-i home. The last disaster drill was conducted on 12/18/2022.

Medications: Medications review began at 11:50 a.m.; medications are centrally stored and locked in a cabinet in the living room. The LPAs also observed medications that required refrigeration to be locked in a concealed bag in the refrigerator in the garage. Medications are labeled and checked for expiration dates. The LPAs advised the Administrator to ensure that all the necessary information is properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

Infection Control: The facility has a central entry point for symptom screening and temperature checks. The LPAs were requested to sign in upon entry. 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, staff schedule, surety bond, and liability insurance.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.