Routine inspection·May 24, 2022

Licensing Program Analyst(s) (LPA) Mary Flores and Valeria Maldonado conducted an unannounced annual visit with focus on infection control domain, food, and medication review. LPAs met with Griselda Cisneros caregiver and explained the reason for the visit. Administrator Laura Aguilar Assistant Administrator. Facility is licensed to served 6 non-ambulatory residents over the age of 60 with a hospice waiver for 6. Facility is a single home in a residential area. Facility has a living room, kitchen, dining room, 4 resident bedrooms, 2 bathrooms, a front porch, and a back yard. No large bodies of water were observed. Facility has a shaded area in the backyard. LPAs initiated tour of the facility with Griselda Cisneros and continued tour with Laura Aguilar assistant administrator and observed the following: Smog/Carbon Monoxide detectors are interlace were tested and in working condition. Facility has sound devices in all exit doors. Kitchen was observed storing sufficient food for at least 2 days of perishables and 7 days of non-perishables, sharps and cleaning supplies were locked under kitchen's sink. All resident bedrooms have sufficient lighting, all required furniture and bedding supplies. Bathrooms have grab bars and skid mats, water temperature was tested as follow bathroom #1(B1) tested at 109.3 degrees F. and bathroom #2(B2) tested at 113.5 degrees F. which is within the required 105-120 degrees F. Medications and files were reviewed for all 6 residents, Resident #1(R1),#2(R2), and #3(R3) have a bedridden status on their physician's report. Facility does not have a bedridden clearance on file. Staff files were reviewed for staff #1,#2,#3. All COVID recommendations are being followed. Except for N95 Fit testing for staff. Administrator certificate for Luis Aguilar #6020261740 expiration date: 9/23/22 was observed. Deficiency was noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Laura Aguilar Assistant Administrator and a copy of this report, LIC809D,technical advisory, and appeal rights were provided.