Routine inspection·March 13, 2025

On 3/13/2025 at 9:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Licensee, Aurora Fe Jaquias and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory with a hospice waiver for 4. LPA toured facility with Licensee 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 in the residents’ shared bathroom was measured at 116.2 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 2/26/2025. Emergency Disaster Plan not available. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 01/10/2025. At 9:30AM, LPA reviewed 5 of 5 residents records. At 10:10pm, LPA reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. REPORT CONTINUES LIC809-C. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: LPA observed a male working at the facility who is not associated or cleared in Guardian Immediate $500 Civil Penalty Facility does not have an available emergency disaster plan LPA observed unlocked medications in the refrigerator LPA observed PUB475 poster is not posted correctly and is too small LPA observed that facility does not have required oxygen signs posted *** Civil Penalties in the amount of $500 were assessed on todays date*** Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 03/25/2025: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report Change of Administrator Documents Current Administrator’s Certificate The following deficiencies were observed (see LIC 809D) and 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. Appeal Rights and a copy of this report provided.