Routine inspection·May 27, 2025

On 05/27/2025 at 3:25 PM, Licensing Program Analysts (LPAs) Y. Brown and L. Hall conducted an unannounced 1-Year Required inspection. LPAs met with Administrator, Aurora Balancio and explained the purpose of the visit. The Administrator certificate #7000305740 and expires on 03/26/2027. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPAs toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of three (3) bedrooms and one and one-half (1-1/2) bathrooms. No bodies of water was observed. A comfortable temperature is maintained at 81 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 121.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non skid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 05/19/2025. Emergency Disaster Plan was last posted on 05/01/2025. First aid kit was observed to be complete. Fire drill was last conducted on 03/4/2024. Continued on LIC809. Continued from LIC809. LPAs reviewed four (4) resident files and 3 out of 4 resident files were incomplete. LPAs reviewed (3) staff files and 2 out of 3 staff did not have any training records. LPA observed the following deficiencies: At 3:42 PM, LPAs observed during record review that R1, R2, and R3 files were incomplete. At 3:47 PM, LPAs observed during record review that R1 and R2 had missing Hospice care plans. At 4:06 PM, LPAs observed during record review that S1, S2, and S3 had missing required training. At 4:21 PM, LPAs observed refrigerator, freezer, and cabinet that contained can and dry goods was unsanitary. At 4:26PM, LPAs observed four (4) trimmers, a bicycle, a treadmill, a shovel, a stationary bicycle, a weight bench, wire plant trellis', and motor scooter in back yard. At 4:27 PM, LPAs observed the master bedroom was missing screens on the patio door and bathroom window. At 4:33 PM, LPAs observed 2 (two) bottles of 409 Multi-surface disinfectant cleaner, 1 (one) Pine cleaner, 2 (two) bottles of bleach Clorox disinfectant, 1 (one) Lysol disinfectant and air freshener in the unlocked bathroom cabinet. LPA requested the following documents to be submitted to CCLD by 06/03/2025. LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (Last page) Liability Insurance Continue to LIC809C Continued from LIC 809C Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due date, and any repeat violations within 12-month period may result in civil penalties. Exit interview conducted. A copy of appeal rights and this report provided.