Routine inspection·February 12, 2025

On 02/12/2025 at 9:53AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Caregiver, Joy Ballares and explained the purpose of the visit. Administrator, Ronan Rances arrived at 10:28AM. The facility’s fire clearance was approved for four (4) non-ambulatory and two (2) ambulatory residents. Hospice waiver approved for four (4) residents. LPA toured facility with caregiver, Joy Ballares including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of six (6) total bedrooms, one (1) bedroom vacant and one (1) bedroom occupied by staff and two (2) bathrooms. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 68 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 119.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of nonperishable and 2 days of perishable foods. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was purchased on 01/10/2025. First aid kit was observed to be complete. Fire drill last conducted on 02/05/2025. Emergency disaster plan updated 05/05/2024. Continue on LIC809C Continued from LIC809. One (1) staff file reviewed during visit; all other staff files were not available for review during visit. LPA reviewed all four (4) resident records. LPA requested the following documents to be submitted to CCLD by 02/19/2025 LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance LPA observed the following deficiencies: At 10:59AM, LPA observed facility didn’t have Pub 475 poster posted. At 11:02AM, LPA observed unlocked garage with Arm & Hammer laundry detergent, Clorox bleach, Tide laundry detergent pods, Ensuno fabric softener, Xtra laundry detergent,Comet, bleach, All-purpose cleaner with bleach, Simple green all-purpose cleaner and Finish powerball dishwasher tabs. At 11:14AM, LPA observed unlocked kitchen cabinet with medications. Civil penalty of $250 is being assessed for repeat violation . At 12:12PM, LPA observed record review no personnel records were at the facility for review. At 12:30PM, LPA observed record review all four(4) residents were missing Pre- Admission Appraisal. Deficiency is 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 and a copy of this report, LIC421FC and appeal rights provided.