Routine inspection·March 3, 2025

On 03/03/2025 at 8:50 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Belen Rodriguez, and explained the purpose of the visit. Administrator certificate is current. The facility’s fire clearance was approved for all six (6) may be non-ambulatory and one hospice. LPA toured facility with Administrator 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. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 106 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars, non skid shower pan, 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 serviced on 03/25/2024. Emergency Disaster Plan was last posted on 03/21/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 01/05/2025. At 9:08 AM, LPA reviewed 6 residents records. At 9:48 AM, LPA reviewed 5 staff records. At 11:47 AM, LPA reviewed 3 samples of residents' medications. Continue to LIC809-C... Continue from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/10/2025: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:30 AM, LPA observed during record review that R2 to R5's file was incomplete. At 10:30 AM, LPA observed during record review that S4 and S5's files was incomplete. 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 Administrator. Appeal Rights and a copy of this report provided.