Routine inspection·June 18, 2025

On 06/18/2025 at 9:15 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Back Up Administrator, Warlita Rivac and explained the purpose of the visit. The Administrator was unable to come during the visit and gave authorization for Back Up Administrator to sign the report. Administrator certificate is current. LPA toured facility with inside and out including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents, 1 bedroom is occupied by staff, and one office space. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 71 degrees Fahrenheit. 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 109.2 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. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 06/18/2025. Emergency disaster drill was last conducted on 03/10/2025. At 10:44 AM, LPA reviewed 5 residents records. At 11:08 AM, LPA reviewed 3 staff records and all have current first aid training and associated to the facility. At 12:00 PM, LPA reviewed two sample of 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 06/26/2025: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Infection Control THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 9:30, LPA observed unlocked cleaning supplies such as Ajax, Lysol Spray, Borax and unlocked medications such as Nyquil, Allergy Medicine, and Suppositories. At 9:37 AM, LPA observed a rotten tomato in the fridge and expired canned goods in the storage room. At 11:35 AM, LPA observed the facility does not have the Administrator records on file. At 11:38 PM, record review showed that there was no staff training conducted. At 11:55 AM, LPA observed all residents' record is incomplete. At 12:16 PM, LPA observed R1, R2, and R4 have half bed rails with no doctor's order for it. 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. Appeal Rights and a copy of this report provided.