Routine inspection·October 26, 2024

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met Mariciel Gamboa, Administrator and explained the purpose of the visit. The facility has a capacity of six (6) residents and is licensed to serve elderly residents age 60 and above. The facility was approved for six (6) non-ambulatory residents which may retain four (4) hospice residents. Facility have 24 hour awake staff. Currently, all four (4) residents are non-ambulatory. Annual fees are current. Today's visit, CARE tool was used, a tour of the facility was conducted, medication/facility files were reviewed, staff/residents/food supplies were interviewed. The facility is a single family home, located in a residential area, consisted of living room, dining area, attached garage/storage, kitchen, pantry, TV room, three (3) resident bedrooms, two (2) bathrooms and staff office/lounge room. All rooms were furnished with required furniture. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 117.5 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies were observed. Facility maintains a comfortable temperature for residents. Sufficient supply of perishable and nonperishable foods were observed. Smoke detectors and carbon monoxide detectors are operable. Smoke detectors in the hallway and bedrooms are hard wired. Fire extinguisher was mounted in the kitchen wall and fully charged. The outdoor activity area has a shaded patio with ample seating. Medication are centrally stored in a locked storage room and inaccessible to residents. Resident records are stored in a locked storage room and inaccessible to residents. Deficiency was observed and cited in LIC 809D. An exit interview was conducted. LIC 809s report were discussed and provided to facility Administrator.