Routine inspection·November 6, 2023

On 11/6/2021, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced Annual required visit to My Mother’s Place Facility. LPA was met by Licensee Hilda Lozano and the purpose of today’s visit was explained. The facility is licensed for six non-ambulatory residents, and currently houses four (4) residents. LPA toured the facility with Hilda Lozano, Administrator, including but not limited to the kitchen, a total of six bedrooms in the home, 5 for residents, and 1 personal . LPA inspected the laundry area, garage, and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA and Hilda toured the physical plant. All rooms were inspected. Beds and bedding supplies were present, and adequate lighting was provided. The kitchen was inspected and there is perishable and non-perishable food available. Bathrooms were found to be within Title 22 regulation. Toilets and water faucets worked properly. Shower was free of mold/mildew, adequate lighting, and sufficient toiletries accessible to clients. Water temperature properly measured between 105*-120F* (119.5*). Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. Fire extinguishers were charged, smoke detectors and carbon monoxide were operable. LPA and Hilda toured the backyard and LPA observed that there is a shaded area present. There were no bodies of water present. LPA observed a storage room located behind garage with food, supplies and PPE. LPA reviewed Medication Records and observed them to be maintained in order and accurate. cont'd on 809-C LPA found that the oven is not operational and licensee did not have staff’s Cardiopulmonary resuscitation, (CPR) cards readily available. Deficiencies are being cited based on LPA observations and interviews conducted in accordance with the California Code of Regulations, Title 22, Divisions 6 chapter 1, see LIC 809D. An exit interview was conducted, Plans of Corrections were discussed and a copy of this report and appeals rights were and left with Administrator Hilda Lozano whose signature on this form confirms receipt of these documents.