Routine inspection·March 28, 2025

On this day, March 28, 2024, at 4:10 pm., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Virginia Rulete and Blesilda Yamat, and informed the reason for visit. LPA called and spoke over the phone with Leticia Velasco, licensee, and Max 'Mike' Neri, administrator (ADM). The licensee authorized to have the staff to be with LPA in touring the facility. LPA inspected the kitchen, dining area, living room, bedrooms, bathrooms, front, side and backyards. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Facility has smoke and carbon monoxide detectors that were observed in operating condition. Hot water temperature in the common bathroom was tested. Fire extinguisher was observed fully charge with tag showed serviced 3/06/25. LPA observed the following: -at 4:25 pm, medications in the refrigerator in unlocked garage. -at 4:27 pm, unlocked kitchen shears and medication (Aspirin) in the kitchen cabinet. -at 4:28 pm, kitchen cabinets where sharps and cleaning supplies are kept do not have an appropriate lock. -at 4:30 pm, Vitamins and perineal skin protector in cabinet without lock in the area adjacent to the dining area. ...continued on 809C (page 2) Page 2 -at 4:42 pm, shaving cream in one of the residents' rooms. -at 4:43 pm, razor in food tray in another resident's room. -at 4:44 pm, disinfectant and sanitizing sprays in the common bathroom. -at 4:50 pm, hot water in the common bathroom was at 134.1 degrees Fahrenheit. -at 5:02 pm, Isopropyl alcohol and urinary tract infection (UTI) pain reliever in the drawer in another residents' room. -at 5:04 pm, piece of metal, mattress, bed frame and bed rail in the backyard. -at 5:05 pm, rake outside the storage in the backyard. -staff (S1) is fingerprint cleared, however, not associated to this facility. Administrator to submit copies of the following updated/current documents by April 11, 2025: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in additional civil penalties. Deficiencies and plan and proof of corrections were discussed with licensee and ADM over the phone. Licensee authorized Virginia Rulete to sign and receive this report. Due to time constraint, LPA to come back to continue the inspection. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.