Routine inspection·February 27, 2025

On 02/27/2025 at 11:20 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Care Staff, Trifina De Leon and explained the purpose of the visit. The Administrator was unable to come today and gave authorization on the phone for staff to sign. The facility’s fire clearance was approved for six (6) non-ambulatory and two (2) hospice waiver. LPA toured facility with staff inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 4 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature was measured at 107.9 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last purchased on 11/27/2024. Emergency Disaster Plan was last posted on 02/02/2024. First aid kit was observed to be complete. Fire Drill was last conducted on 01/03/2025. At 12:34 PM, LPA reviewed 5 residents records. At 1:00 PM, LPA reviewed 5 staff records and associated to the facility. At 2:00 PM, LPA reviewed two sample of resident’s medications. Continue to LIC 809-C... Continue from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/13/2025: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 11:44 AM, LPA a screw locking the side gate in which the ramp leads in the backyard. Staff stated that they lock it for resident safety. Civil Penalty of $500 is assessed. At 12:05 PM, LPA observed a wall dividing the staff room in half. At 12:30 PM, LPA observed that staff uses the bathroom and as a passageway in R1 and R4's room. Staff stated that they are using the bathroom. At 3:03 PM, LPA observed that R1 and R3 has half bed rail with no doctor's order. At 4:00 PM, LPA observed that the Administrator certificate expired in 2022. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Staff. Appeal Rights and a copy of this report provided.