Routine inspection·March 26, 2025

On 03/26/2025 at 2:30PM, Licensing Program Analysts (LPAs) Carol Fowler and Yasamin Brown conducted an unannounced 1-Year Required inspection. LPA met with Caregiver, Guadeliza Evangelista. The administrator arrived at 3:50PM. Second Administrator, Marc Rico arrived at the facility at 4:30PM. Second administrator, Marc Rico holds a current certificate which expires on 10/23/2026. Administrator, Elvira Vahid certificate has expired as of 10/23/2024. Administrator Elvira stated she completed her 20 hours of training's and will update certificate in the near future. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Caregiver including but not limited to bedrooms, bathrooms, kitchen, garage, common area, and back yard. The facility consists of four (4) total bedrooms and three (3) bathrooms. All outdoor and indoor passageways are kept free of obstruction. 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 112.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. Smoke detectors/ carbon monoxide were in operating condition during visit. Fire extinguisher was last purchased on 03/26/2025 during visit. First aid kit was observed to be complete. Fire drill was last conducted on 01/05/2025. Continued from LIC809. LPAs reviewed six (6) staff records which were incomplete. LPAs Reviewed four (4) resident records which were found incomplete. LPAs requested the following documents to be submitted to CCLD by 04/02/2025. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report Resident roster LIC 610E Emergency Disaster Plan (last page) Liability Insurance LPAs observed the following deficiencies: At 3:00Pm, LPAs observed syringes and doorknob missing in room #3. At 3:05PM, LPAs observed an unlocked garage door which contained medications, bleach, tide, Zinc, Vision formula, collagen, and Liposomal medication. At 3:15PM, LPAs observed facility did not have 7 days of non perishable and 2 day perishable foods. At 3:17PM, LPAs observed a roach trap on the kitchen counter and a roach crawling on the dishwasher. At 4:00Pm, LPAs conducted record review and witnessed staff and resident records are incomplete. 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 the appeal rights and this report provided.