Facility Evaluation Report

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Caregiver. Licensees (Bot) and Edward Alicdan arrived later. Facility currently has 3 residents in care one of which is on hospice, which is allowable per the facility's Hospice Waiver. .

At approximately 9:00am LPA and Licensee toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. LPA and Licensee observed the following food items to not be covered or labeled: sliced cake, 1/2 of a tomato, brown liquid in a cup, and red sauce in a bowl. Per Title 22 regulation 87555(b)(9) General Food Service Requirements - (b) The following food service requirements shall apply: (9)Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service ( deficiency cited, see 809D ). LPA and Licensee observed one bowl of cooked pasta on stove top in cooking pot not properly covered. Per Licensee, pasta left out overnight and during the day before, at room temperature. Per Title 22 regulation 87555(b)(23) General Food Service Requirements (b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures ( deficiency cited, see 809D ). LPA and Licensee observed kitchen drawer containing sharp knives not locked. Per Title 22 regulation 87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s) ( deficiency cited, 809D ).

All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. LPA and Licensee observed rash bins in residents rooms are not covered. Per Licensee, trash bin in R2's room contained soiled brief for at least 2 days. Per Title 22 regulation 87303(f)(3) Maintenance and Operation (f) Solid waste shall be stored and disposed of as follows: (3) All containers, except movable bins, used for storage of solid wastes shall have tight-fitting covers on the containers; shall be in good repair; shall have external handles; and shall be leakproof and rodent-proof ( deficiency cited, see 809D ).