Routine inspection·June 5, 2025

On 6/5/2025 at 1:45pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-Year required inspection. LPA met with Laly Bascao, Caregiver, Caregiver , and explained the purpose of the visit. The facility’s fire clearance was approved for four (4) ambulatory, two (2) non-ambulatory, of which one may be a bedridden resident. Facility has a hospice waiver for two (2). LPA toured the facility with Caregiver including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of six (6) total bedrooms two one-half (2-1/2) bathrooms. LPA observed pool in the backyard has locked gate. A comfortable temperature is maintained at 73 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 99.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 11/23/2024. Emergency Disaster Plan was last reviewed on 5/1/2025. First aid kit was observed to be complete. Continued on LIC809. Continued from LIC809. LPA reviewed five (5) staff and all six (6) resident records. LPA reviewed a sample of three (3) residents' medication. LPA observed the following deficiencies: At 2:15pm, LPA observed during record review there was not any training conducted by staff. At 2:50pm, LPA observed R6 did not have dresser/chest of drawers in the bedroom, R1 did not have a dresser/chest of drawers in the bedroom, and R2 did not have a night stand or lamp in the bedroom. At 3:00pm, LPA observed facility has one (1) bedridden, five (5) total non-ambulatory, and one (1) ambulatory resident, which does not meet fire clearance. At 3:05pm, LPA observed a walker, hoyer lift, 7 wheelchairs, a broken table, and 4 raised toilet seats in back yard, behind and on right side of house in back yard. At 3:07pm, LPA observed exit gate locked with padlock on right side of house. At 3:13pm, LPA observed insulin unlocked in refrigerator. At 4:30pm, LPA observed facility was no conducting fire drills. *An immediate civil penalty of $1000.00 will be assessed on today's date* ($500.00 for 87705(f) for padlock and $500.00 for 87202(a)(1) fire clearance for non-ambulatory). Continued on LIC809C. Continued from LIC809C. LPA requested the following documents to be submitted to CCLD by 6/12/2025. Resident Roster LIC 308 Designation of Administrative Responsibility Liability insurance. LIC 500 Personnel Report LIC 610E Emergency Disaster Plan. 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, LIC421M, and this report provided