Routine inspection·April 1, 2025

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Annual Required 1-year Visit on 04/01/2025. LPA was met by Staff Karla Pablo Damian and explained the purpose of the visit. Administrator Amanda Palomino arrived later to assist with the visit. Vannesa Hinojosa was also present and assisted with the visit. The facility is licensed to serve six (6) residents over the age of 60, of which six (6) may be non-ambulatory and has a hospice waiver approved for four (4). Two (2) out of the six (6) residents in care are currently on hospice care. LPA OBSERVATIONS: The facility is a single-story dwelling located on in a residential neighborhood and consists of three (3) resident bedrooms, one (1) staff bedroom, two (2) shared bathrooms, kitchen, dining room, living room, detached garage, front yard, and backyard. LPA Lopez observed auditory device on entry of door to be operational, sliding door and exits. Physical Plant: Front Yard: Is well maintained and no hazards were observed during visit. Kitchen: LPA Lopez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Lopez observed knives and sharps located in kitchen cabinet, to be inaccessible to residents in care. LPA observed several bottles of cleaning solutions and disinfectants located in kitchen cabinet, to be inaccessible to six (6) out of six (6) residents in care. Kitchen appliances were observed to be clean and in working order. LPA observed staff preparing lunch for residents during visit. Monitor was observed to be mounted near sink area and accessible to residents, staff, and visitors. LPA Ramirez has addressed this issue on previous visit. . Dining Room/Living room/: Dining room was observed to be clean and contained one table with plenty of seating. LPA Lopez observed five (5) out of the six (6) residents seated in this area during the visit. ( See 809-C for continuation). (continue on 809) Laundry room: LPA observed detergents and disinfectants to be inaccessible to residents in care. LPA Lopez observed two (2) emergency food buckets in laundry cabinet. Linen Closet: Contained plenty linens, towels, hygiene products and PPE supply. Resident Rooms 1-3: All resident rooms are shared, and LPA observed a camera mounted in the corner of resident room #3. LPA Ramirez has previously addressed this issue. LPA observed all three (3) resident bedrooms to contain required furnishings, lighting, and linens. Bathrooms 1-2: Water temperature in two (2) resident bathrooms were within 105.0 – 120.0 degrees F. Bathrooms were observed to be clean and well stocked. LPA observed signage promoting proper hand washing etiquette. Backyard: Well, maintained and no hazards were observed. Plenty of shade and seating was observed. Emergency Drills/Emergency Disaster Plan: Last documented drills were conducted on 03/01/2025. Emergency disaster plan (LIC610) was observed, reviewed and needs updating Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. LPA observed fire extinguisher near kitchen to be fully charged. Personnel Records: Personnel records are maintained at facility. LPA reviewed staff files for three (3) staff. LPA observed Administrator’s certificate for Amanda Palomino with an expiration date of 06/15/2026.. Resident Records: Five (5) resident records were reviewed. Medication for four (4) residents were reviewed and medication was administered according to doctor’s orders. Liability Insurance & Infection Control Plan: LPA requested and obtained a copy of liability insurance and infection control plan. Exit interview was conducted. No deficiencies were observed. Technical Advisories provided. A copy of this report was provided.