Routine inspection·May 20, 2025

Licensing Program Analyst (LPA) Daniel Konishi conducted the unannounced required annual inspection. LPA arrived unannounced and met with Caregiver Sandra Portillo Alvarde. Administrator, Lorraine Lopez, arrived shortly thereafter to assist. The purpose for the visit was explained. The facility is licensed for residents ages 60 and over. 6 Ambulatory, of which 5 may be non-ambulatory and 1 may be bedridden. Hospice Waiver for 6 residents. Currently, there are two (2) residents are on hospice. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: Facility has an updated infection control plan in place. The facility staff and residents continue to practice the hand washing and disinfecting the facility each shift. The facility has sufficient PPE supplies. 2. Operational Requirement: The facility has approved for 5 non-ambulatory and 1 may be bedridden currently there's only one resident is bedridden which is within the fire clearance requirement. LPA observed current Liability insurance in place. The facility has a dementia care plan to accept or retain residents with dementia. 3. Physical plant and Environmental Safety: The facility is a single-story house and located around the neighborhood area. The facility include living room, staff break room with a divider, six residents’ bedrooms, three residents’ bathrooms, kitchen, dining area, family room and attached garage. Laundry washing machine and drying machine is in the garage. 3. Physical plant and Environmental Safety: Each resident has one bed, one chair, one drawer and required furniture and beddings and sufficient lighting and closet space. All three resident's bathrooms are clean, sanitary and in a good working condition. The hot water temperature in all three bathrooms were tested between 113.7- and 114.1 degrees F which is within Regulations. The bathroom has the required non-skid mat and grab bar in the shower. There are two fireplaces with one in the living room and one in the family room is adequately screened and secure. All the appliances in the kitchen are working properly. The sharp knives and utensils are stored and locked in the kitchen drawer. All the dish soap are stored and locked under the sink. All cleaning supplies and chemicals are stored and locked in the cabinet located in the garage. All the extra personal hygiene products are stored and locked in the garage cabinet. The facility has a telephone on the premises. The carbon monoxide detector are working well in the facility. The facility has a pool in the backyard and it's locked and gated with a fence. The passageway, walkway and patio are free of obstruction. Fire Extinguisher located in the kitchen is fully charged and was last inspected on 04/21/2025. 4. Staffing: Facility has a sufficient staffing to provide care and supervision to the residents. Each facility staff has an updated First aid and CPR certificate. The NOC shift staff has an updated facility emergency planned procedure training. 5. Personal Records-Training: All staff are over 18 years old, fingerprint cleared and associated with the facility. LPA reviewed the admin and three (3) staff files which includes: personnel record, Health Screening, TB test result, Employee Rights, ongoing staff training and medication management training. The facility administrator is Lorraine Lopez and certificate expire 11/13/2025 and she has the required training hours as a qualified administrator. 6. Resident's Right: The RCFE complaint poster and personal right poster posted on the wall in the living room. The facility has internet service and provide at least one internet access device such as computer or tablet and equipped with video conferencing and residents can have meetings with their family or their physician if needed. 7. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 8. Food Service: The facility has sufficient food supply including minimum 2 days perishable and 7 days non-perishable. The facility kitchen is clean and well-kept and in a operable condition. The food are properly stored in the refrigerator to avoid cross contamination. No resident required a modified diet that's prescribed by the doctor. Facility staff will chop the food for resident to prevent choking. 9. Incidental Medical and Dental: The facility will arrange residents' medical and dental appointment if needed. All the resident's medication are centrally stored and locked in the cabinet in the hallway. LPA inspected all six residents’ medication and they all seemed accurate and updated and they all have 30 days’ supply of medication. 10. Resident Record-Incident Reports: All the resident file in the facility has all the required documents including emergency identification and information form, signed admission agreement, updated medical assessment, Ambulatory Status, TB test results, Resident Appraisal, Personal Rights, Centrally Stored Medication Destruction Record, Safeguards for Personal Property/Valuables, functional capability assessment, pre-appraisal and appraisal / needs and service plan, and medication list in the file. 11. Disaster Preparedness: The facility has an updated emergency Disaster plan in place. The facility has at least two appropriate alternative shelter location. The last disaster drill was conducted on 03/19/2025. The emergency exit plan and telephone number posted on the wall in the living room. 12. Resident with Special Health Needs: Currently the facility has two residents on hospice and one bedridden and it's within the requirement and fire clearance. All staff does have the required training for the hospice and dementia residents. The hospice residents has the updated information in their hospice record along with the resident's file. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were observed during the visit. Exit Interview conducted and a copy of the report was provided to the Administrator, Lorraine Lopez.