Routine inspection·April 1, 2025

On 04/01/2025 at 12:40 PM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Mirriam Para and explained the purpose of the visit. Administrator certificate is current. The facility’s fire clearance was approved for capacity of six (6) all may be non-ambulatory and hospice waiver of four (4). LPA toured facility with Administrator inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 5 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. 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. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 05/26/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 01/16/2025. At 12:54 PM, LPA reviewed 2 residents records. At 1:15 PM, LPA reviewed 3 staff records and all have current first aid training and associated to the facility. At 3:20 PM, LPA reviewed resident’s 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 04/05/2025: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 1:30 PM, LPA observed that alterations were done without a building permit. At 2:00 PM, LPA observed the medication cart unlocked. At 2:30 PM, LPA observed the hot water temperature measured at 124.8 degrees F. At 3:25 PM, LPA observed resident's medication without a doctor's order. At 3:38 PM, LPA observed that both residents did not have a doctor's order for their half bed rails. At 4:30 PM, during record review, LPA observed that the facility has not paid their annual dues. 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.