Routine inspection·June 18, 2024

Licensing Program Analyst (LPA) Christian Gutierrez conducted the annual inspection using the Compliance and Regulatory Enforcement (CARE) tools. LPA met with Administrator Rafael Estanislao at approximately 11:08 AM and explained the reason for the visit. The facility has a capacity of six (6) residents. It is licensed to serve elderly residents aged 60 and above, approved for six (6) non-ambulatories, of which one (1) may be bedridden. Facility approved for two (2) hospice waivers. The facility cares for elderly residents with dementia. Currently, facility has three residents with dementia. Annual fees are not current. Administrator has been advised and pin number provided. The facility is located in a residential neighborhood, a single-story home and consisted of six (6) resident’s bedrooms, two (2) bathrooms, living room, staff room, kitchen, dining room, outdoor laundry, back house for live in staff. LPA Gutierrez conducted a tour of the facility, reviewed records, and interviewed 2 staff. The following were observed: Four (4) out of six (6) Bedrooms have the required furniture such as bedframes, dressers, lamps, and chairs. Bedrooms #1 and # 4 are missing chairs. Beds have the required linen, and the linen is in good condition. There are 2 bathrooms. Bathroom #1 have the required grab bars in the shower and near the toilet and is missing nonskid mat. Bathroom #2 grab bar in shower is broken non-skid surface/mats in place. Bathrooms# 2 was observed to have cleaning supplies unlocked in cabinet and accessible to residents. The hot water temperature was 107.3-109.4 degrees during the visit, which is within the required 105 - 120 degrees. The facility temperature at the time the visit was comfortable There is sufficient lighting throughout the facility There are smoke detectors located throughout the facility. There is a carbon monoxide detector in the hallway. The kitchen was inspected. There was a sufficient supply of 2 days perishable food, and Seven (7) days non-perishable foods were observed. The front and backyard are well maintained. LPA observed cleaning solutions on patio floor accessible to residents There is no pool or other large bodies of water. The facility is required to have auditory devices on exit doors for dementia residents. The auditory devices were observed to not be working in two (2) out of six (6) resident rooms at the time of the visit. There are no cameras in the facility. Four (4) staff files were reviewed and missing required documents. Five (5) residents files were reviewed and five (5) out of five (5) were missing required documents. Last fire/earthquake drill was conducted in April of 2023. Infectious control plan was missing. Two (2) staff were interviewed. Six (6) out of (6) residents’ medications were reviewed. Medications are centrally stored and locked MAR log is used. Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided.