Follow-up on corrections·May 9, 2025

Licensing Program Analysts (LPAs) Elena Mallett & Luis De Leon, and Licensing Program Manager (LPM) Fernando Fierros conducted an unannounced case management visit to check facility compliance for hospice waiver request per title 22. LPAs was greeted by current Administrator Paula Mera and the purpose for today’s visit was explained. FACILITY PHYSICAL PLANT The facility is in a residential area. The facility is made up of five (5) client bedrooms and one (1) staff room, one (1) full bathroom for residents and one (1) full bathroom for staff, living room, dining room, laundry room, front shaded porch, and backyard, and an attached car garage. There were no body of water observed in the property. The facility has charged fire extinguishers. The building contains central air conditioning and heating. REVIEW OF FILES Resident record review consisted of Physicians Report for six (6) out of six (6) residents, hospice plan for four (4) out (6) residents, and medication written orders for six (6) out of (6) residents. During the visit, Administrator Paula Mera reported the passing of resident R3 the night before 5/8/2025. Administrator will send CCLD a death report for R3 and document cause of death for hospice reason care . Staff roster and staff facility association were reviewed. Report continues on page 809C... Observations during facility tour with assistance of Administrator Mera.: · Upon arrival, auditory device at main entrance was not working when door is opened. Per California Code Regulations, Title 22, facilities with dementia residents are required to have an auditory device to monitor exits on exterior doors. · Bedrooms were furnished with a bedframe, dresser, lamps, and chairs. LPA observed that there was clean linen, bath towels, and personal hygiene with reasonable closet space available for clients. The facility has full bedrail orders for four (4) out of six (6) residents (R1-3, 5). Wall and floors are in good repair. Hallways were clean and free of obstructions. · Kitchen appliances were in working order and clean. There is sufficient two (2) days of perishables and seven (7) day supply of non-perishable food. Dining room has sufficient seating area. · Toilets, showers, and water faucets are cleaned and free of mold. Restrooms were stocked and clean. The water temperature was tested and measured. A deficiency is noted for hot water in the resident restroom measured 124.1 and 124.5 for both sinks which is above the regulatory requirements in California Code of Regulation, Title 22. · Disinfectants and sharps were observed in the garage and accessible to residents with Dementia. Therefore, a deficiency is noted on page 809D. · Smoke detectors were observed in all bedrooms and carbon monoxide detectors was observed in the living room leading up to the bedrooms. All smoke detectors are interconnected throughout the facility. Two (2) fire extinguishers were observed at kitchen and garage and were fully charged. · Front and back yards have shaded seating area. · The medications are centrally stored and locked in the office. LPAs and LPM review the request for increase of hospice waiver request with Administrator. Due to deficiencies noted during visit. The administrator will a request a hospice exception for resident who aged in place at the facility but has started hospice care. The administrator stated that facility will rescind hospice waiver request and, instead, submit the hospice exception request to the department by 05/12/25.. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D pages. Exit interview held and a copy of the reports (809, 809C, 809D and appeal rights) along with appeal rights were provided to Administrator Paula Mera.