Routine inspection·February 26, 2024

Licensing Program Analysts (LPAs) Valeria Conway and Martha Arroyo arrived at the facility unannounced to conduct a required annual visit. The last annual visit was done on 12/21/2022. Administrator Zenaida Velasco opened the door at 2:45 PM. and explained the reason for the visit. Administrator reported to LPAs that the facility does not have any residents at this time, that her family is living at the residence. No residents present. LPAs toured the physical plant areas inside and outside, with Administrator at 2:55P.M. BEDROOMS: There are (4) four bedrooms designated for resident use. Bedroom #2 and Bedroom #4 have a direct exit to the exterior. Each bedroom has adequate lighting. Bedroom #3 leads to a hallway, which allows for access to Bedroom #5 and Bedroom #6; however, those two rooms designated for staff. There is an exterior door that leads to Bedroom #5 and Bedroom #6. Staff are aware that once they have residents in Bedroom #3, staff would need to enter their rooms through the exterior door. At 3:04P.M. room #1 had a locked door and Administrator was unable to open. Administrator stated she did not have a key to the room. RESTROOMS: There are (2) bathrooms designated for resident use. There is a bathroom designated for staff use only. Bathrooms are in operating condition with grab bars and non-skid surfaces. The LPAs advised the Administrators to ensure that bathrooms were stocked with paper towels and hand-washing signs prior to allowing resident admissions. Hot water temperature was tested throughout the home and was within normal ranges between 105.0 F and 120.0 F. Continued on LIC 809-C Continued from LIC 809 COMMON SPACES: At the time of the visit, common seating area and dining room furniture were observed to be in good condition. The common spaces included the living room, dining area, activity room, entertainment room and office area. The LPAs observed cameras in all common spaces and exterior. The LPAs did not observe the required postings in the common hallway and Administrator was aware they are required to post posting throughout facility upon admission. Fire extinguishers were observed to be serviced and fully charged, last serviced on 03/27/2023. The backyard has a covered outdoor area equipped with furniture for resident use. There are no bodies of water noted. KITCHEN: Appliances in the kitchen appeared functional. The supply of perishable and nonperishable food is adequate. INTERVIEWS: No residents interviews as facility has no residents. RECORDS: No residents file reviewed as facility has no residents. One (1) personnel record was reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Facility does not have an Administrator file at the facility. MEDICATION REVIEW: No medication reviewed as facility has no residents. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Administrator was informed that failure to correct the deficiencies may result in civil penalties. Administrator Zenaida Velasco refused to sign report at the time of the exit interview. A copy of the report was printed and issued to Administrator.