Facility Evaluation Report

Licensing Program Analysts (LPA) Sarah Hurt and Vadim Gorbam conducted an unannounced visit today for the facility’s annual inspection. LPA met with Administrator Surinder Ahluwalia, Continual Administrator's Certification expires 01/13/2027. There are currently 5 residents who reside at this home and there is 0 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable.

Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector. Water temperature was tested at 113 degrees. First Aid kit is on site and complete.

The facilities Infection Control Plan has not been reviewed annually. The facilities Emergency and Disaster Plan LIC610E has not been reviewed annually. LPA's observed cleaner disinfectant in Resident 1's bathroom, and bleach cleaning products in hallway bathroom accessible to residents. Resident 2's bedroom is missing desk lamp. Staff 1 does not have CPR/First aid training. Staff 2 does not have LIC503 Health Screening Report. LPA's observed back patio furniture without cushions, backyard grass is dry and overgrown. LPA's observed two backyard window screens with holes. Resident 3's medication was not properly logged on the Centrally Stored Medication record. The facility is not using designated bedrooms on original facility sketch as listed (office is being used as a resident bedroom.) The facility does not have proof of required disaster drills.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Administrator, Surinder Ahluwalia, and copy of report left at facility