Routine inspection·June 19, 2025

On 6/19/25 an unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan. Upon arrival, LPA met with the facility Administrator Elena Angustia, who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. LPA Khurshudyan reviewed the required postings on a wall throughout the facility. The inspection tool was used to complete today's visit. During today's visit, LPA conducted a physical plant walk through at approximately 10:55am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22.The following was observed: The facility is a single-story home and is licensed for capacity of six (6) residents, of which six (6) may be non-ambulatory and of which fire clearance for one (1) Bedridden. Facility also has a hospice waiver for one (1) resident. There are five (5) bedrooms designated for residents’ use. All bedrooms observed to be appropriately furnished and have appropriate lighting. There are two (2) bathrooms in the facility designated for residents’ and staff use. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 11:15am to be 123.1°F. Extra towels and linens were readily available in the linen closet located in the hallway. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination. LPA observed facility alarms were present on all exit doors and signals were operational. SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 12:30pm they were tested and observed to be operational. The facility has two (2) fire extinguishers that was last purchased on 7/16/2024. Continue on LIC809-C KITCHEN: The facility has a Kitchen area that is equipped with a two (2) refrigerators, microwave oven, dish washer and sink. The kitchen appliances and fixtures were functional. LPA observed the kitchen area to be dirty and not sanitary. There was sufficient stock of one-week non-perishable foods and two days of perishable foods. Stored foods were not properly labeled. Food storage and preparation areas observed to be cluttered and unorganized. LPA observed that sharp objects were stored inside the unlocked kitchen cabinet and accessible to residents in care. LPA also observed chemical bug spray on the kitchen floor and informed by the caregiver that there is a cockroach in the facility. Extra emergency food was also stored inside the kitchen cabinets. Temperature was measured at 12:35pm to be 81°F. MEDICATION: LPA observed centrally stored medication unlocked inside one of the staff’s unlocked room and numerous medications openly placed on the kitchen table. First Aid kit was locked inside the hallway storage cabinet, inaccessible to residents in care and it was checked by the LPA to be complete. Facility has two (2) staff for AM shift and one (1) awake caregiver for PM shift. COMMON AREAS: LPA observed the living room and the dining room to be generally clean and furnished, however, the area was cluttered by files, documents, papers etc. Facility has land line; LPA checked its operational. There is a fireplace, which is blocked by the sofa and LPA was informed that the fireplace is not-operational. LAUNDRY ROOM: Laundry machines are located outside of the facility inside locked fenced area. LPA observed chemicals stored openly in the kitchen and staff room areas, available to residents residing in the facility. LPA discussed the importance of keeping potentially dangerous items locked at all times. SURROUNDING GROUNDS: LPA observed sufficient yard space with fenced backyard. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. Exit doors were unlocked however, obstructions were observed on the exit areas. The facility does not have a swimming pool or body of water. FILE REVIEW : Between 11:00am to 12:30pm, LPA reviewed records and files of two (2) residents and three (3) staff/caregivers. A review of staff and resident records appeared to be not complete. There are no residents with prohibited conditions residing at the facility. Continue on LIC809-C An emergency exit plan/sketch along with other posting requirements are posted on the wall by the entrance area. Medications Review : At approximately 12:35pm LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. All medications were properly recorded, however, PRN medications did not have written orders from a physicians. LPA collected LIC500, LIC9020, copy of Liability Insurance Certificate. Deficiencies issued during today’s visit. Exit interview conducted and copy of this report signed and delivered.