Routine inspection·April 25, 2024

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Veronica Hernandez, staff, who assisted with the visit. The facility is licensed to serve six (6) non-ambulatory residents who are ages 60 and above and approved for three (3) Hospice Waiver. Facility had dementia program on file. Annual licensing fees are current. LPA discussed the purpose of today's visit with staff and licensee. During the visit, LPA conducted staff/resident interviews, used inspection tool, toured the facility, reviewed food supply, reviewed medications, and reviewed staff/residents records. The facility is a single family home located in a residential neighborhood, consisted of six (6) bedrooms, three (3) bathrooms, living room, dining room, activity/sun room, laundry room, kitchen, and indoor/outdoor activity areas. Sufficient supply of perishable and non-perishable foods was observed. Medications were centrally stored, locked and inaccessible to residents in care. All the rooms are furnished with appropriate furniture for residents’ comfort. Bathrooms are furnished with grab bars and nonskid surfaces. Hot water temperature is measured at 116.5 degrees Fahrenheit which is within Title 22 Regulation guidelines. Sufficient of linen supplies and personal hygiene supplies are observed. Auditory device alarms are operational. Smoke detectors and carbon monoxide detectors were tested and operable. Fire extinguishers were fully charged and last service was on 12/5/23. The outdoor area has a shaped area and seating. No deficiency was cited per California Code of Regulations, Title 22. An exit interview was conducted. This report is discussed and provided to Licensee, whose signature on this form confirm receipt of these documents.