Routine inspection·May 8, 2025

Licensing Program Analysts (LPA) Alberto Lopez conducted an unannounced annual inspection visit. LPA met with Monica Aguilera, Administrator. The purpose of today's visit was discussed. The facility is licensed to serve six (6) non-ambulatory residents who are ages 60 and above and approved for six (6) Hospice Waiver. Facility has dementia program on file. Currently, one (1) resident is on hospice. Annual licensing fees are current according to Administrator. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. 2. Operational Requirement: Liability Insurance is updated and in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. 2) PHYSICAL PLANT 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/sunroom, laundry room, kitchen, and indoor/outdoor activity areas. All the rooms are furnished with appropriate furniture for residents’ comfort. Bathrooms are furnished with grab bars and nonskid surfaces. Hot water temperature was measured at 106.5 to 109.5 degrees Fahrenheit which is within Title 22 Regulation guidelines. Sufficient supplies of linen 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 02/14/2025. The outdoor area has a shaped area and seating . (continued on 809C) (continued from 809) Behind the clothes dryer is an accumulation of lint from the dryer that needs to be removed. The refrigerator needs to be clean inside and out and the floor leading to and in the garage is uncleaned. 4. Staffing: The facility has sufficient staffing, and the night supervision staff have current CPR/first aid certification. 5. Personnel Record-Training: All the staff files are maintained in the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. 6. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Pre-admission appraisal/Appraisal Needs & Services Plan. 7. Resident Rights-Information: The Complaint, ombudsman and CCLD poster are posted by entry. Visiting hours are included in admission agreement. 8. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 9. Food Service: The kitchen was inspected and did have sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be very clean and sanitary. Pesticides and cleaning supplies are kept away from the food preparation areas. 10. Incidental Medical and Dental: All Medication is centrally stored and locked in the medication cabinet near the the kitchen. Four (4) centrally stored resident medications were reviewed, which contained 30-day supply of medications. All mediations are administered as ordered by the physician. Disaster preparedness: The last fire drill was conducted on 05/01/25. The facility has an Emergency Disaster Plan (LIC610E) but it was not posted at facility. . 12. Resident with Special Health Needs: 1 resident is receiving home health services. No resident is currently on postural support. Individual Service Plans and Appraisals are on file. Deficiencies observed during today’s visit. An exit interview was held. A copy of this report, 809D and appeal rights were provided.