Routine inspection·April 1, 2025

Licensing Program Analysts (LPA) Jose Villalobos conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Administrator Flordeliza Sasada. The following12 (CARE) tool domains were utilized during the inspection: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. Facility has mitigation plan but will need to update into an infection control plan. Notice provided. Physical Plant/Environment Safety: The facility is located in a residential area which contains: Living room, kitchen, dining area, 4 Resident bedrooms, 2 bathrooms, laundry area and a detached garage. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are enclosed ponds in the backyard. Cleaning supplies and toxic substances are inaccessible. Water temperature readings measured within title 22 regulations. Operational Requirements: A current Plan of Operation observed. FACILITY IS CLEARED FOR 6 AMBULATORY OR NON-AMBULATORY RESIDENTS. BEDRIDDEN FIRE CLEARANCE APPROVED FOR BEDROOM #3. HOSPICE WAIVER GRANTED FOR 1 Continued on LIC 809-C Personnel Records - Staff Training: Administrator on file is current Staff have criminal background clearances. Four (4) staff files were reviewed. Staffing: Sufficient staff observed during visit Resident Records - Incident Reports: A total of four (4) resident files were reviewed. Required documents observed on file Resident Rights - Information Required postings observed Food Service: Sanitation practices and kitchen cleanliness was observed. Kitchen has utensils for clients to use and to store their meals No cleaning supplies stored near food Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Incident Medical and Dental: First Aid Kid observed (4) of (4) Resident medications reviewed Disaster Preparedness: Emergency and Disaster Plan observed Residents with Special Health Needs: Currently (1) resident receiving home health services. Home health documents observed Inspection Tool was completed and no Title 22 deficiencies are being cited on todays visit. Exit interview conducted and a copy of this report was provided