Routine inspection·October 29, 2024

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to staff Jeffrey Sandejas. A ssistant Administrator Danielle Maximo arrived shortly after. The facility is licensed for 4 elderly developmentally disabled residents 60 years and older. The facility is licensed as a level 4C RCFE vendored by San Gabriel/Pomona Regional Center. The following 12 Care Compliance and Regulatory Enforcement (CARE) tool domains were utilized during the inspection. The following were observed/inspected: Infection Control: The Infection Control Plan was reviewed. The facility has a supply of Personal Protective Equipment (PPEs). Operational Requirements: The facility has a Dementia plan and hospice waiver for four (4) residents. A fire clearance for four (4) [3 non-ambulatory & 1 bedridden] residents age 60 and above, of which 1 resident may be bedridden in room #1. Facility handles resident P & I monies. The Surety Bond expires 2/8/2025. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 6/20/2025. Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. The facility has one (1) fully charged fire extinguisher. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Cleaning supplies, knives, and toxic substances were observed unlocked/accessible to residents above the washer/laundry area. Two (2) broken chairs and a dresser were observed in the patio area. The side yard has a discarded shelf rack. Citation was issued. Staffing: A total of 8 staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expired 7/10/2024. Proof of pending approval from CCL Recertification Unit was provided. Staff have criminal background clearance and training. Four (4) staff files were reviewed. Proof of staff training, health and TB clearance, and 1st Aid/CPR training are on file. Resident Records/Incident Reports: Four (4) resident files were reviewed. They contained admission agreements, IPPs, Behavior Plans, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent. The facility maintains centrally stored medication records. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. The facility has a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Two (2) residents have a modified diet plan. Incident Medical and Dental: Centrally stored resident medications were reviewed, which contained a 30-day supply of medications. Medical and dental transportation is provided by facility staff. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. The last emergency disaster drill was conducted on 9/13/2024. Residents with Special Health Needs: No residents are receiving hospice services or home health services. One (1) resident has a restricted health care plan on file. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Assistant Administrator Danielle Maximo. A copy of the report and appeal rights was issued.