Routine inspection·November 25, 2024

On 11/25/2024 at 1:30pm, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the annual inspection. LPA met with Evangeline Agatep, Administrator and the purpose of the visit was discussed. Facility is licensed to serve 6 non- ambulatory residents of which (1) maybe bedridden. Three (3) the residents are diagnosed with dementia, two (2) residents are receiving home health (0) residents are receiving hospice care services. The facility does not handle any of the residents’ money. The last fire drill was conducted on 10/03/2024. The facility fee is $494.50 and is due on 12/05/2024. LPA provided the pin #055870 to the facility to make annual fee payment online. The home is a single story home consisting of: (5) resident bedrooms, (2) full bathroom, den, living room, kitchen with dining area, laundry room (located in the kitchen) and two (2) outdoor shaded patio area. LPA toured the resident bedrooms which have the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. 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, water temperature measured at 113.1 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Report continues on LIC 809-C Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. Deficiencies cited under California Code of Regulations (Title 22, Division 6, Chapter 8); LPA observed the following deficiencies: On 11/25/2024 at 1:40 PM while LPA was conducting a tour of the physical plant, LPA observed: resident beds had bedrails and reviewed records for Resident #1, Resident #2, Resident #3 and Resident #5 files and did not observe a physicians order on file for the half bed rails. padlock on exterior gate For Resident #2, on the physicians report it states that the resident is bedridden, when resident is not bedridden. An exit interview was conducted with Evangeline Agatep, and a copy of Report and Appeal Rights provided. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. * .