Routine inspection·January 28, 2025

On 1/28/2025, Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced annual inspection. LPA was greeted by caregiver and disclosed the reason of the visit. Administrator was contacted. Administrator will not be available to meet LPA. There are currently three (3) residents who reside at this facility. This facility is approved for six (6) non-ambulatory of which one (1) may be bedridden. Approved hospice waiver for six (06) residents. At approximately 11:30am, LPA toured the facility with staff member and observed the following. LPA observed dual smoke/carbon monoxide detectors that are hard wired and interconnected. Smoke detector was tested @1:15pm and was observed to function properly. The fire extinguisher is located in the kitchen, appeared to be fully charged and was purchased on July 16, 2024. KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. There is also a mini refrigerator, that was observed to be locked, where insulin is being stored. There is an adequate supply of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). An emergency supply of water was also observed in the kitchen. Sharps and knives were observed locked in a kitchen drawer. BEDROOMS: There are three (3) bedrooms designated for resident use. Bedroom #1 is currently occupied by two (2) residents, and bedroom #2 is occupied by one (1) resident. Bedroom #3 is vacant. All three rooms were furnished with beds, night stand, chairs, dresser, bedding and linen. All three bedrooms have sufficient lighting and closet space. BATHROOMS: The facility has two (2) bathrooms. LPA observed the bathrooms to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 115.2 degrees. No cleaning supplies were observed accessible in the bathroom at this time. COMMON AREAS: Facility has one room designated for the living room/activity area. It was equipped with living room furniture, a television, and a coffee table. There is no fireplace. Dining area is located in the kitchen. LPA observed all the furniture in common areas to be in good repair. LAUNDRY ROOM: The laundry room is located in the garage. Cleaning supplies were stored away and inaccessible to the residents. MEDICATIONS: Medications are stored locked in one of the kitchen cabinet. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. The backyard of the facility has a patio and backyard furniture to accommodate the residents. There is a swimming pool that is fenced with a gate that will be kept locked at all times. The fence installed to keep residents out of the swimming pool area is approximately 5 feet high throughout the parameters. A key is required to unlock the padlock to gain entry to the swimming pool as it is kept locked at all times. Adjacent to the swimming pool was another building, which is used for storage. LPA inspected this building and observed used wheelchairs and beds. Facility Records: At 2:30PM LPA conducted review of resident files and staff records. LPA reviewed three (3) out three (3) resident files and two (2) staff records were reviewed to ensure compliance. During staff records review LPA observed staff (S1) who was present at the facility giving care to residents, did not have a staff file. S1 is not associated with the facility. LPA observed Administrator's certificated has expired. Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit Interview Conducted and a copy of the report was issued.