Routine inspection·March 24, 2025

At 9:45a.m., Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection to the facility. LPA met with Caregiver and explained the reason for the visit. Later, Assistant Administrator joined today’s visit. At 10:15a.m., Caregiver and LPA conducted physical plant tour inside and out. During the tour, LPA observed that the facility is a home located in a residential community. The front main door is the only entrance being utilized at the facility, it has six (06) bedrooms and three (03) bathrooms designated for residents and two (02) staff bathroom. Six (06) private bedrooms and three (03) bedrooms designated for live – in staff, and two (02) bedrooms for Administrator’s son and daughter. Three 03) bedrooms designated for the staff is located on the second floor of the facility, which is only accessible by spiral staircase. Spiral staircase has a locked gate only accessible by the staff. Fire/Earthquake drill was last conducted on 03/01/2025. Required posting observed displayed in the facility hallway (complaint hot line poster, personal rights, etc). Temperature of facility wall thermostat is observed and set to 72 Fahrenheit. The fire alarm/CO system was tested and observed to be working, it is hard wired and interconnected. No obstructions and or tripping hazards throughout the facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Common Areas : These included the living room and dining area for residents. The common areas were properly furnished. Furniture in common area was observed to be in good repair. Residents dining table fits six (06) residents. (Continued to LIC 809-C) (Continued from LIC 809) Bedrooms were toured and observed to be clean and properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Linen storage was also checked and observed to have ample supply of clean linen, comforters, and towels in facility. Every bedroom, hallway area and kitchen has smoke/CO detectors that are functional. Bathrooms were observed to be clean, sanitary and with necessary supplies. The appropriate grab bars and mats in the shower. Hot water temperature measured at a range of 107.5°F to 116.9°F and within the required range. Resident’s personal hygiene supplied are kept separate in their private room. Towels and washcloths are not shared. Kitchen Area is observed to be clean and sanitary. Sharps are locked and stored in a cabinet in the kitchen. Toxins, cleaning solutions, and soap stored and locked under the sink. Laundry Room: LPA observed detergent, toxins and cleaning supplies washer and dryer machines located next to the kitchen and inaccessible to residents in care. Fire extinguishers were observed to be located throughout the facility. Fire extinguishers were observed to be operable with service date 01/03/2025. Food : LPA observed at least two (02) days perishable and seven (07) days non-perishable food at the facility that is properly stored. Frozen foods are wrap and stored properly as well. Food storage and preparation areas are clean. Medication and first aid kit were observed to be locked in kitchen cabinet inaccessible to residents in care. Garage is detached to the house and observed to be locked and inaccessible to residents. Surrounding Grounds The front grounds of the facility are well landscaped. All passageways and stairways were observed to be clear from obstruction. The front porch is covered with chairs for lounging at the facility. The outdoor area was enclosed, and there is a pool in the backyard of the facility, which is gated and locked in the premises. Resident Records . Six (06) resident records were reviewed. Three (03) out of six (06) residents record did not have Physician’s Report. Staff Records were also reviewed Administrator’s son and daughter do not have criminal record clearances, associated to this facility. Administrator and Assistant Administrator cardiopulmonary resuscitation (CPR) and first aid training are expired. However, caregiver on duty CPR is current at the time of this visit. Administrator's certificate was observed to be current. Alteration to exciting facility physical sketch was observed, activity area was converted into son’s bedroom. Alteration was done without notifying Community Care Licensing. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies observed cited on LIC809-D during the visit. Exit Interview Conducted / A Copy of the Report was provided to Assistant Administrator.