Routine inspection·August 5, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 9:07AM. The LPA met with the Licensee Rolando Lazatin, who arrived at 10:00AM. Entrance interview conducted. Beginning at 10:07AM, the LPA and Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The facility is a single-story residential home. The following was observed: KITCHEN: The LPA observed knives stored inaccessible in a locked drawer. Cleaning supplies were stored inaccessible and locked under the sink. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food, as well as emergency food. Food in the refrigerator and freezer were observed to be properly stored with labels and dates. Medications and files were stored in a locked cabinet near the refrigerator. One (1) fire extinguisher was observed and purchased on 07/29/2025. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. A fireplace was observed to be properly screened and inoperable. Required postings were located above the fireplace. The facility maintained a comfortable temperature throughout the visit. Night lights and exit signs were observed throughout the facility. Report Continued on LIC 809-C GARAGE: The facility’s garage contained general storage, extra facility supplies, a refrigerator with extra food, emergency water, and laundry machines. The laundry machines were observed to be in good condition and had locked cabinets above that contained detergent and cleaning supplies. The garage remained inaccessible to residents. BEDROOMS/RESTROOMS: There were five (5) total bedrooms: three (3) private resident bedrooms, one (1) shared resident bedroom, and one (1) staff room. Bedroom #5 had a direct exit to the outside. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens were stored in a dresser located in the hallway and in resident bedrooms. There were three (3) total restrooms in the facility: two (2) shared common restrooms located in the hallways and one (1) private restroom attached to Bedroom #3. Restrooms were clean, sanitary, and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap and paper products. Sink cabinets were locked and contained hygiene products. Hot water was tested and measured between 105.8 degrees F and 108.5 degrees F, which is within the required range per regulation. OUTDOOR AREA: The surrounding grounds had one (1) shaded patio area equipped with furniture in good condition for resident and visitor use. The LPA observed three (3) locked sheds in the backyard that contained general storage. There was one (1) emergency exit located on one side of the facility with a self-latching mechanism that led to the front yard. The front yard had a driveway with a manual gate and a regular gate door for everyday use. All exits and passageways were free of obstruction. RECORDS: Record review began at 10:34AM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. Report Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. The emergency disaster plan was observed to be complete and reviewed annually as required. The Licensee was unable to locate the infection control plan at this time. Emergency disaster drills are conducted monthly, with the last documented drill on 07/23/2025. Smoke and carbon monoxide detectors were tested at 10:31AM and were operational. MEDICATIONS: Medication review began at 1:03PM. Medications were centrally stored and kept inaccessible in the kitchen. Medications were observed for three (3) residents. Medications were labeled and checked for expiration dates and were properly documented on the centrally stored medications and destruction record. Three (3) out of three (3) residents were prescribed PRN (as needed) medications. The facility staff administered PRN medications to residents everyday with no documentation of the administration. Resident #1 (R1) was prescribed one (1) PRN medication: Docusate Sodium. Resident #2 (R2) was prescribed three (3) PRN medications: Amlodipine Besylate, AllerClear, and Tylenol. Resident #3 (R3) was prescribed two (2) PRN medications: Midodrine HCL and Acetaminophen. R1 had a PRN Authorization Letter dated 08/21/2017 for Magnesium Hydroxide, which R1 was no longer prescribed. The Licensee did not obtain PRN Authorization Letters for R2 and R3. The Licensee plans to contact Physicians and the Pharmacy to clarify the PRN medications and obtain Authorization Letters. Pursuant to Title 22 CA Code of Regulations and/or Health and Safety Code, the following deficiencies were cited (Refer to LIC 809-D). Exit interview conducted. A copy of the Appeal Rights and report was reviewed and provided.