Routine inspection·February 3, 2025

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit. Upon arrival, no one answered the door and LPA called the Administrator & Licensee. At 10:10am, Brandon Dewalt, arrived and explained the purpose of the visit. At 10:30am, Staci Mitchell, Administrator arrived and assisted LPA with the inspection. The facility is licensed to serve six (6) ambulatory adults 60 years of age or older with developmental disabilities. The facility is vendorized by the Frank D. Lanterman Regional Center, Level 4 home. Current census is (8) because of (2) extra residents from their sister facility, Pasa Alta East (3280 N. Fair Oaks Ave., Pasadena, CA. 91101) that was burned down in the Eaton fire. LPA notified Administrator to contact the Fire Dept. to inform them that they are over capacity and are temporarily providing care for (2) additional residents. LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tool and observed the following: Infection Control: Staff are adhering to infection control requirements. The staff use disposable gloves to clean and disinfect the high touched surfaces in the common areas. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Physical Plant/Environment Safety: The facility is a single-story home which consists of: living room, dining area, kitchen, 4 bedrooms (3 residents and 1 staff), 3 bathrooms, laundry area and front yard. Resident bedrooms were inspected and closet/drawer space to accommodate each resident comfortably was available. The bathrooms are clean and operational. The hot water temperature was tested throughout the facility. Water temperature reading measured within the required 105 - 120 degrees Fahrenheit. Readings were 109.7 deg F in bathroom #1, 107.6 deg F in bathroom #2 and 109 deg F in bathroom #3. The kitchen was observed for the ability to prepare and serve food. LPA observed sufficient food supply of (2) days of perishables and (7 days) of non-perishables. Knives, disinfectants, and cleaning solutions are kept locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were tested and operable. (2) fire extinguishers were fully charged and last serviced on 06/27/2024. The first-aid kit is fully stocked w/first-aid manual. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. A shaded area with chairs is provided in the back yard. The backyard is free of debris/hazards. There is no evidence of bodies of water (pool) or security bars nor weapons on the premises. There are no security bars or weapons on the premises. LPA observed cameras in the common areas with no audio. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked cabinet and are inaccessible to residents. Last fire drill was conducted on 01/21/2025 and disaster drill was conducted on 01/31/2025. Operational Requirements: The facility has an approved fire clearance, there is a plan of operation with required Infection Control Plan and facility maintains the required liability insurance. Surety Bond in the amount of $5000 is in effect and expires on 11/09/2025. *****REPORT CONTINUED ON LIC809-C***** Staffing: A total of twelve (12) staff members including the Administrator and Licensee provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Personnel Records-Training : Staff has criminal record clearance, current First-Aid/CPR training. LPA reviewed (3) staff files with no issues observed. Administrator Staci Mitchell’s certificate expired on 1/20/24 but was able to provide proof of pending renewal and all current training were within the personnel file. Resident Records-Incident Reports: Resident files are kept in a secure location (within staff room/office) and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed (6) Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility provides scheduled activities and have a variety of activities to choose from within the facility. There is an outdoor activity area available for the residents. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7) days of non-perishables. Incidental Medical & Dental: Medication is properly labeled and are centrally stored in a closet and are in their original containers. LPA reviewed (6) residents’ medications and there were no issues observed. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least (2) relocation sites. Residents with Special Health Needs: There are no bedridden or residents with postural supports at this facility. Per the Administrator, there is no resident at this home with incidental medical services nor have a restricted health condition. No deficiencies cited, Technical Assistance issued. Exit interview held and a copy of the report was provided to the Administrator Staci Mitchell.