Routine inspection·December 1, 2023

On 12/1/2023 at 9:30 AM, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual inspection visit to the above facility. LPA met with Caregivers Iosefo Naumati and Imelda Diquit and LPA explained the purpose of the visit. Administrator/Licensee Coty Cabral arrived later and joined the visit. Facility is licensed to serve residents age range 60 and over, six non- ambulatory residents of which, one may be bedridden and approved hospice waiver for two residents. During this visit, there is one hospice resident. This is a single-story home consisting of four resident bedrooms, one staff bedroom, one common bathroom, one ensuite bathroom (bedroom#5), living room, kitchen with dining area, garage, and a shaded outdoor patio. At 9:42 AM, LPA Montoya toured the facility with Caregiver Imelda Diquit. The 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. At 10:30 am, 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. REPORT CONTINUED IN LIC 809-C At 10:40 am, LPA observed the resident bedrooms had 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. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. At 11:15 am, LPA observed the smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. At 11:30 am, LPA conducted records review, staff files, resident files and medication administration records (MARs) are complete. At 11:45 AM, LPA conducted interviews with staff and residents. LPA observed the following deficiencies: At 9:46 AM, LPA observed the filing cabinet where client files are stored has no lock. At 10:03 AM, LPA checked the water temperature in resident bedroom #5 ensuite bathroom and it measured at 120.7 degree Fahrenheit. At 3:08 PM, LPA Montoya checked the water temperature again in the same bathroom and it measured at 124.8 degree F. Deficiencies cited under California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted, and a copy of the report and Appeal Rights were provided to Administrator Coty Cabral.