Routine inspection·August 10, 2024

On 08/10/24 at 9:10 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Licensee Vicenta Mendoza. This facility is licensed to serve 6 adults ages 60 and above, of which 4 may be non-ambulatory residents. Facility must maintain a 24-hour awake staff. Facility is approved for 6 hospice residents. The facility currently has one resident on hospice. The facility is a one-story house located on a residential street. The home consists of 3 resident bedrooms, 1 staff bedroom, 2 bathrooms, 1 dining/living room, 1 kitchen, 1 attached garage, and a front yard and backyard patio area with shaded seating. The Licensee accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, and hot water temperature properly measured at 109.2 degree F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Continue to LIC809-C. Common areas were clean and clear of hazards and doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, last serviced January 10, 2024 was observed in the kitchen area. Staff tested the carbon monoxide detector and smoke detectors in the house. Both devices were functional. 5 staff records were reviewed. 5 resident records were reviewed and 5 out of 5 resident records had admission agreements. Two residents’ medication was reviewed. Deficiencies are being cited based on LPA’s record review in accordance with the California Code of Regulations, Title 22, see LIC809D. LPA did not observe 20 hours of annual training for staff #1, #3, #4, and #5. An exit interview was conducted, plans of correction developed, technical assistance provided, and a copy of this report was discussed and left with Licensee Vicenta Mendoza.