Routine inspection·July 22, 2025

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Micaella Cisneros (Caregiver) and explained the purpose for today’s visit, shortly after Assistant Administrator Maria Tavarez arrived to assist with visit. The facility is licensed to serve 4 Non-Ambulatory Developmentally Disabled Residents ages 60 and over, and is approved for 1 Hospice Resident. The facility currently has 1 ambulatory and 3 non-ambulatory residents, which are serviced through Harbor Regional Center. The facility is a single-story home located in Lakewood, Ca. A tour of the facility includes: 4 Resident Bedrooms, 2 Bathrooms, 1 Staff Room, Living Room, Dining Area, Kitchen, attached garage with laundry, front yard and back yard. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and the initial visit and observed the following: Infection Control: Facility maintains the required Infection Control Plan. Operational Requirements: The facility maintains the required liability insurance. Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The front yard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for clients. The hot water temperature was tested and measured within the required range of 105-120 degrees F. All storage areas for cleaning solutions, toxins, knives, and hazardous items are kept in a locked and are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguisher was observed and is fully charged. (Continued on LIC809-C) Staffing : There appears to be sufficient staffing at all times in the facility. Personnel Records-Training : Staff has criminal record clearance, current First-Aid/CPR/AED training along with training in postural supports, medication assistance, and other ongoing training are documented in personnel files. LPA reviewed 4 staff files with no issues observed. Flormine Resurreccion Administrator Certificate expired 7/8/25 pending renewal as of 6/3/25 per CCL website. Resident Records-Incident Reports: Resident files are kept in a secure location 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 4 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: 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 cabinet and are in their original containers. LPA reviewed 4 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. Last fire/disaster/earthquake drill was conducted on 7/1/25. Residents with Special Health Needs: There are no bedridden or residents with postural supports at this facility. Staff maintain valid CPI certificates. 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 was emailed to minniebanos@yahoo.com and mariadtavarez@gmail.com