Routine inspection·December 1, 2023

Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced site visit for the Required - 1 Year inspection. Upon arriving at the facility, LPA discovered there was no one present. LPA called facility phone number and shortly after Staff member / Medical Coordinator/ Martha Ramos arrived and later Wendy Vasquez/ DSP Supervisor arrived at the facility and assisted with the visit. The facility is licensed to serve six (6) Non-ambulatory Residents ages 60 and over. The facility is vendored with the San Gabriel/ Pomona Regional Center, level RCFE 4C. LPA used CARE Inspection tool to conduct todays visit, a tour of the physical plant was conducted alongside with Martha Ramos, medication was reviewed with Wendy Vasquez, staff and resident file review and staff interviews were conducted. No resident's present during visit therefore no resident interviews were conducted. The facility is located in a residential area. A tour of the single-story facility includes: (3) resident bedrooms, (2.5) resident bathrooms, living room/ office area, dining room, kitchen, laundry room/ pantry, (2) backyards observed and no large body of waters observed. Kitchen and food supply was observed, operable equipment and thermometers in place for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables, facility has a pantry with food supplies. All storage areas for cleaning solutions, toxins, knives, and hazardous items are in a secured cabinet and inaccessible to clients. Kitchen Cabinets a total of two drawers are not on track, un-leveled and not sturdy, deficiency noted. There is a functioning telephone and internet on the premises. Continuation 809-C... The bathrooms are clean and operational. Hallway Bathroom were observed water stains / marks , brown and black spots observed on the wall and ceiling and stains and cracks observed on the door casing frame, and paint coming off the wall. Uneven tiles with missing door threshold between the hallway floor and bathroom fall, causing a tripping hazard, deficiency cited. The hot water temperature was tested throughout the facility and warning sign for water temperature that exceeds over 120F posted above the kitchen sink (used staff only). -Hallway was observed to have water stain on ceiling and on door casing frame leading to the pantry room, deficiency cited. -Flooring was observed to have uneven, piling and indented and cracked titles in dining room, living room and in pantry room, deficiency cited. Residents bedrooms had required furniture, lighting and bed sheets/linen. Room #2 was observed to have ceiling water stains and broken door casing frame, deficiency cited. Resident bedrooms were checked and closet/drawer space to accommodate each resident comfortably was available. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. The outdoor activity area is free of visible hazards and debris and the trash cans have covered lids. There are no security bars or weapons on the premises. All medications for residents are kept locked and inaccessible to other residents. LPA reviewed medication and Medication Administration Record book and found no deficiencies. The first-aid kit is fully stocked w/First-aid Manual. LPA reviewed resident medications. Administration Certification for Hector Vargas expires: 6/23/2024 Liability Expires:7/15/2025. Smoke detectors and carbon monoxide detectors are operable and in compliance. The fire extinguishers were observed to be fully charged and in compliance. Emergency/ Fire Drill Expires: 09/10/2023 Per Title 22 Regulations, deficiency cited, see LIC809-D and TA was given for window/wall cleaning. An exit interview was conducted and a copy of this report was provided to Wendy Vargas.