Routine inspection·July 15, 2025

On 07/15/2024 at 8:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Maria Luisa G Estavillo and explained the purpose of the visit. The facility’s fire clearance was approved for 6 non-ambulatory and a hospice waiver for 5. LPA toured facility with Administrator 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 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 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 117.5 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. Centrally stored medication and sharps were not locked and inaccessible to residents. LPA observed facility van to be clean with valid registration. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 9/19/2024. Emergency Disaster Plan was last posted on 12/12/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 7/19/2024. At 10:00am, LPA reviewed 6 residents records. At 11:00am, LPA reviewed 4 staff records and 3 of 4 have current first aid training and associated to the facility. Report continues on LIC809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: LPA observed unlocked medications in a small cabinet in the living room next to red recliner LPA observed unlocked scissors and cleaning solutions in the hallway bathroom drawer LPA observed that the right side walkway/pathway and exit is blocked with various items being stored in the area. LPA observed that fire drills are not up to date LPA observed that emergency disaster plan is not current LPA observed that Administrator who assists in care giving does not have valid first aid certificate. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 8/1/2025: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance 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.