Routine inspection·May 27, 2022

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Staff, Noemi Pradomartinez, Administrator, Humberto Santamaria, and Assistant Administrator, Carmen Santamaria, who assisted with the visit Facility is licensed to serve six (6) non-ambulatory residents who are ages 60 and above. Facility has approved for six (6) hospice waivers. Annual licensing fees are current. Administrator certificate is current and the expiration date is 12/21/23. During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed. This facility is located in a residential neighborhood, single story house. Facility consisted of five (5) resident bedrooms, two (2) bathrooms, one (1) staff room/office, living room, TV room, dining room, garage with laundry area, kitchen, and backyard with patio. All residents' rooms were furnished with appropriate furniture for residents’ comfort. The bathrooms were furnished with grab bars and nonskid surfaces. Common areas were observed for the ability to safely serve the needs of the residents. Hot water temperature measured at 110.7 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. No pools and bodies of water on the premises. Facility maintained a comfortable temperature for residents. Auditory alarm devices to monitor exits were operable. Interior and exterior space available to permit residents to wander freely and safely. Sufficient supply of perishable and nonperishable foods is observed. Knives, tools, sharp items are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable. Fire extinguishers’ last service is 4/25/22 and are fully charged. (- continued in LIC 809C -) The first aid kit is fully stocked. Mandated documents and signages are posted in common areas. The outdoor activity area has a shaded patio with ample seating. Medication are centrally stored in a locked closet and inaccessible to residents. Resident records are stored, locked and inaccessible to residents. Toxic substances are inaccessible to residents. No deficiencies were observed and cited per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed with Administrator, Humberto Santamaria and Assistant Administrator, Carmen Santamaria . Administrator's signature on this form confirm receipt of these documents. A copy of LIC 809s report were provided.