Routine inspection·May 12, 2023

On 05/12/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA arrived and was greeted by Caregiver Elias Valentino. LPA introduced self, stated the purpose of the visit, and was granted entry. LPA requested to meet with Administrator. Caregiver and LPA attempted contact via telephone Administrator Amalia Necer. Caregiver and LPA was unable to reach Administrator. LPA conducted tour with caregiver. Administrator Amalia Necer arrrived later during inspection. All five residents were present during inspection. The tour started in the common areas, to kitchen and into the residents’ bedrooms. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. LPA observed COVID-19 related signs. Fire extinguisher was observed with a service date of: 07/16/19. Medications were checked and observed kept medication drawer. Residents’ MARS was reviewed. Refrigerator temperature maintained at 37 degrees F and freezer temperature at 0-degree F. An adequate supply of perishable and non-perishable food was observed. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. LPA observed 2 shared residents’ bed to be at least 6 feet apart and one single occupant rooms. Bathrooms were properly equipped. Hot water temperature was tested 107.4 degrees F in main bathroom and range from 113.3 to 111.6 degrees F in shared bathroom. Outside of facility toured. Side gate was self-closing and self-latching. Carbon monoxide and smoke detectors were tested and observed to be operational. All residents’ file reviewed to have Admission agreement. A deficiency is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6. LPA will return on a later date to conduct an Annual Continuation inspection to review personnel records. Exit Interview conducted. A copy of this report and appeal rights was discussed and provided to Administrator Amalia Necer, whose signature on this form confirms receiving this document.