Routine inspection·October 10, 2023

On 10/10/23 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA was greeted by the Administrator Merlita Nepomuceno. LPA observed covid-19 signs at the front door and required postings were observed on a wall by the living area. LPA Rios explained the purpose of the visit to the administrator. At 10:20 a.m. LPA and administrator Merlita conducted a physical plant tour to ensure the health and safety of the residents in care. The following was observed: Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of 2-day perishable and 7-day non-perishable food at the facility; properly stored. Knives were stored in a locked cabinet in the kitchen. Cleaning products were stored in a locked cabinet under the kitchen sink. Medication stored in a locked kitchen cabinet. Bedrooms: There are four (4) bedrooms of which four (4) are designated for residents' use. Three of the bedrooms are currently occupied. Bedroom #3 is currently vacant. Rooms occupied by residents were properly furnished with appropriate beddings and linens with sufficient lighting. LPA observed a full bed rail on resident #1's (R1's) bed. Bathrooms: There are two (2) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was taken from one (1) of two (2) bathrooms at 10:40 a.m. and read between 105 and 120 degrees Fahrenheit. Common Areas : These included the living area and dining area. The common areas were clean and properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. (Continued to LIC809-C) The smoke alarms are battery operated and interconnected. LPA observed a carbon monoxide detector by the living area and kitchen. Staff #1 (S1) tested smoke and carbon detectors at 10:43 a.m. and were observed to be functioning properly. The fire extinguisher is located in the kitchen with purchase date 07/14/23. Surrounding Grounds : The outdoor area was free of hazards and has a covered patio with outdoor furniture. LPA observed a shed used for storage. A staff room that is maintained locked leads to the laundry room which leads to the garage. LPA observed a deep freezer with food. Detergents and cleaning products are kept in the laundry room locked. Resident Files : LPA conducted a file review of resident records to insure compliance of licensing forms at 12:08 p.m. LPA's record review for resident #1 (R1), R1 had an order for a full bed rail but R1 is not terminally ill according to R1's physician's report. According to Licensee Nathan, R1 is receiving Hospice service for palliative care. Staff Files : LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms at 12:35 p.m. Medications : At 1:43 p.m. LPA and administrator reviewed medication and medication records for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiency observed during the visit refer to LIC809-D. Exit Interview Conducted. Appeal Rights provided. A copy of the report Issued.