Routine inspection·March 27, 2025

On 03/27/2025 at 1:10pm, Licensing Program Analysts LPAs L. Hall and Y. Brown conducted an unannounced 1-year required inspection. LPAs met Jessie Del Rosario, Caregiver. LPAs spoke with Administrator, Marcelina Badeo, via telephone and explained the reason for the visit. Administrator arrived at 3:15pm. The administrator currently holds a certificate (#6035565740) that expires on 06/02/2025. The facility’s fire clearance was approved for five (5) Non ambulatory and one (1) Bedridden residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of seven (7) bedrooms and three (3) bathroom. Two (2) bedrooms are occupied by staff. LPA observed pool in the back yard is accessible to residents. Fence has gate with lock, but other side not connected. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPAs 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. Night lights are maintained in hallways and passages. Residents’ bathrooms are equipped with grab bars no and non slip mats Continued on LIC809C. Continued from LIC809C. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 01/22/2025. Emergency Disaster Plan was last posted on 03/8/2025. First aid kit was observed to be complete. Fire drill was last conducted on 3/20/2025. The following forms to be updated and submitted to CCLD by 4/3/2025: LIC 610E Emergency Disaster Plan Residents roster Updated facility sketch for patio room and door for #6 Liability Insurance LIC308 Designation of facility responsibility LIC500 Personnel record LPAs observed the following deficiencies: At 1:25pm, LPAs observed that S3 was not associated to the facility. A 1:25pm, LPAs observed four (4) unlocked kitchen cabinets containing medication, and refrigerator in unlocked storage room with medicine. At 1:27pm, LPAs observed facility had six (6) bananas, 1/2 gallon of milk, 1/2 loaf of bread, 20 canned foods. LPAs did observe facility had frozen meats, a bag of carrots, and lemons. At 1:30pm, LPAs observed laundry room unlocked with Febreeze, cleaning vinegar, Clorox, and Carpet shampoo. LPAs also observed hallway closet unlocked containing two (2) gallons of Clorox. At 1:40pm, LPAs observed the swimming pool in the back yard was accessible on the left hand side of the gate. Continued on LIC809C. Continued from LIC809C. At 3:30pm, LPAs observed during record review facility did not submit a hospice notification for R1, R5, and R6. At 4:00pm, LPAs observed R1 did not have a chest of drawers, R5 and R6 did not have a night stand. Civil penalties of $1000.00 will be assessed on today's date ($500 for 87355(e) and $500 for 87307(e)(2)(A). Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights, LIC421IM, LIC421BG, and a copy of this report provided.