Routine inspection·May 16, 2023

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit using the CARE Tool. LPA met with Elizah Arganosa (Caregiver) and explained the reason for the visit. The facility is licensed to serve 6 non-ambulatory residents, of which 1 may be bedridden in the age range of 60 and over. The facility has hospice care waiver for 4 residents. The facility is operating within the scope of its license. A tour of the single-story facility included: living room, kitchen, dining area, 5 resident bedrooms, 1 staff bedroom, 2 resident bathroom, backyard, front yard and attached garage. LPA and Elizah Arganosa toured the facility and the following was observed: the front and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. Auditory devices were seen on exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in both bathrooms and measured at 116.2 degrees F and 118.4 degrees F which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in a hallway closet. Smoke detectors were observed in each room and throughout the facility, and were properly operating. There is a carbon monoxide in the dining are and was properly operating. There is one fire extinguisher located in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps kept locked in a kitchen cabinet and are inaccessible to residents. Cleaning supplies and toxins are kept locked under the kitchen sink and are inaccessible to residents. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. First Aid kit was fully stocked with current manual and it is kept locked in the medication cabinet. Residents and staff files are centrally stored in the medication cabinet. Residents medication are centrally stored in a locked kitchen cabinet. (Continued to LIC 9099-C) LPA reviewed medication for all 5 residents and observed that medications are documented properly and given as prescribed for 4 out of the 5 residents. Facility did not have 2 medications for Resident 1 (R1). LPA reviewed all 5 resident files and 5 staff files. LPA observed administrator certificate for Thang D Duong – 6052097740 with an expiration date of 06/02/2023. LPA interviewed 2 staff, 1 resident and attempted to interview 4 residents. Per California Code of Regulations, Title 22, and California Health and Safety Code, there was one deficiency observed during the visit (Refer to LIC 809-D). Exit interview held and a copy of the report and appeal rights were provided.