Routine inspection·June 20, 2023

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility using the CARE Tool. LPA Mora met with Maria Tavarez (Administrator) and explained the reason for the visit. The facility is licensed to serve four (4) non-ambulatory, developmentally disabled elderly residents ages 60 and above. Facility is approved for hospice waiver for two residents. One of the residents is currently at a rehabilitation hospital. A tour of the single-story facility included: living room, kitchen, dining area, 4 resident bedrooms, family room, 2 bathrooms, front yard, backyard and attached garage. LPA and Maria Tavarez toured the facility and the following was observed: the front and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. There are no bodies of water at the facility. Passageways and exits are free of obstruction. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in both bathrooms and measured at 112.9 degrees F and 106.8 degrees F which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen in each resident bedroom’s closet and clean towels in a hallway closet. Smoke detectors were observed in each room and throughout the facility and are properly operating. There is one carbon monoxide in the hallway and is properly operating. There is a fire extinguisher in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps, cleaning supplies and toxins are kept locked under the kitchen sink and are inaccessible to residents. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. First Aid kit was fully stocked with current manual and it is kept locked in a hallway cabinet. Facility has a screen on the fireplace. The facility has a video camera surveillance system in all common areas and hallway. All residents signed the video camera surveillance system plan of operation and there was signs posted throughout the facility indicating video camera in use. Residents medication are centrally stored in a locked cabinet in the living room. Residents and staff files are centrally stored in the medication cabinet. (Continued to LIC 809-C) LPA reviewed medication for all 4 of the residents and observed that medications are documented properly and given as prescribed. LPA reviewed files for all 4 residents and 5 staff and observed no issues with the files. LPA observed administrator certificate for Maria D Tavarez – 6028010740 with an expiration date of 08/25/2023. LPA reviewed P&I funds for all 4 residents with a staff present. Facility has a liability insurance and a surety bond on file. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report were provided.