Routine inspection (multi-day)·June 6, 2025

On 06/05/25, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection. On 06/06/25, LPA conducted a subsequent unannounced annual continuation and met with Staff. The facility is licensed to serve six (6) non-ambulatory residents, of which one may be bedridden. The facility has a hospice waiver approved for six residents. Bedrooms #1, #2, and #4 are approved for non-ambulatory or bedridden residents. Annual fees are current. The facility consists of five (5) resident bedrooms, two and one half (2 ½ ) bathrooms, kitchen with office space, family room/activity area, dining room, staff bedroom adjacent to the family room, and shaded patio. The facility is clean, sanitary, and in good repair. The Co-Administrator 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 security bars or weapons on the premises. Beds and bedding were in good condition, adequate lighting provided, walls and floors were in good repair. Continue to LIC809-C. 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, hot water temperature properly measured above 123 degree F and a hot water temperature warning sign was prominently placed. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean, 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 toxins were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, last serviced September 10, 2024 was observed in the kitchen area. Licensee tested the carbon monoxide detector and smoke detectors in the house. All devices were functional. Four (4) staff records were reviewed, four out of four staff records had required criminal record clearances or criminal record exemptions and first aid certificates. Five resident records were reviewed and, five out of five resident records had medical assessments and pre-appraisal. Two residents’ medication was reviewed. Deficiency was observed on 06/05/25 and cited from the California Code of Regulations, Title 22. 1. During record review, LPA did not observe TB results for Staff #2 (S2). Interview with S2 indicated that S2 has to complete the TB test. 2. During record review of facility sketch, it revealed rooms #3 and #5 as ambulatory. Record review of register of residents revealed two non-ambulatory residents (R3 and R5) in rooms #3 and #5. Record review of medical assessment revealed R3 and R5 as non-ambulatory. Continue to LIC809-C. An exit interview was conducted, plans of correction developed and reviewed, technical assistance provided, and a copy of this report with the appeals was discussed and left with the Co-Administrator Rodolfo "Nino" Lozada.