Routine inspection·June 10, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 8:46AM. The LPA was greeted by Administrator Arlene Ceballos, informed them of the reason for the visit, and they proceeded to notify the Licensee Izhak Illouz. Licensee arrived at 9:50AM. Entrance interview conducted. Beginning at 8:54AM, the LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility is a single story residential home. The following was observed: BEDROOMS/RESTROOMS: There are seven (7) total bedrooms; six (6) private resident bedrooms and one (1) locked staff bedroom. Bedrooms #3, #4, and #5 have direct exits to the outside, and Bedroom #3 is cleared for bedridden residents. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens are stored in a dresser located in the hallway. There are six (6) total restrooms in the facility: five (5) attached private resident restrooms and one (1) common restroom located in the hallway. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured between 113.2 degrees F and 115.3 degrees F which is within the required range per regulation. Report Continued on LIC 809-C COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. Required postings were located on the entryway wall. LPA observed a screened fireplace in the living room. The facility maintained a comfortable temperature throughout the visit. Fire extinguishers were observed throughout the facility and was last serviced on 01/03/2025. OUTDOOR AREA: The surrounding grounds had multiple shaded patio areas equipped with furniture in good condition for resident and visitor use. LPA observed one (1) water fountain that was surrounded by garden plants and shrubs. There were two emergency exits located on both sides of the facility with a self-latching mechanism. All exits and passageways were free of obstructions. The LPA observed one (1) shed in the backyard that contained general storage and extra facility supplies. There was one (1) carport which was converted into an office, with an attached shed/closet that contained general storage and emergency water. The sheds and office remain locked and inaccessible to residents in care. KITCHEN: The LPA observed knives stored inaccessible in a locked drawer between the stove and sink. 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 within regulation. Food in the refrigerator and freezer were observed to be properly stored with labels and dates. Grocery shopping occurs every Monday and Tuesday. Medications are stored in a locked cabinet near the rear exit doors as well as the laundry machines, which was observed to be operational during the visit. RECORDS: Record review began at 9:32AM. 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. Both documents were observed to be complete and reviewed annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 04/10/2025. Smoke and carbon monoxide detectors were tested at 10:00AM and were operational. Additionally, the facility does monthly smoke/fire alarm checks and replaces batteries if necessary. MEDICATIONS: Medication review began at 10:05AM. Medications are centrally stored and kept inaccessible in the kitchen. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates and were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. Two (2) staff and two (2) residents were interviewed. No complaints noted. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.