Routine inspection·November 9, 2023

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Administrator Rosamaria Maximo. Assistant Administrator Danielle Maximo arrived later. There are four (4) level 4C developmentally disabled adults over the age of 59. The facility is vendored by San Gabriel/Pomona Regional Center. A fire clearance for 4 non-ambulatory adults is in place. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. Visitors are no longer being screened for COVID-19. The facility has an Infection Control Plan. Operational Requirements: The facility has a Dementia plan and hospice waiver for four (4) residents. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 6/20/2024. Facility handles resident's money. A Surety Bond in the amount of $2,000 is in place. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood. The facility is staff operated and consists of 4 private resident bedrooms, 2 bathrooms, living room, dining room, kitchen, outdoor patio area and laundry area in 2-car attached garage. 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. Kitchen drawers containing knives/sharp objects were locked. The facility has one (1) fully charged fire extinguisher, fire pull alarm, and operable carbon monoxide and smoke detectors. Water temperature readings did not measure within the required 105 - 120 degrees Fahrenheit. Citation was issued. Staffing: A total of 10 caregiver staff provide care and supervision to the clients. Resident Records/Incident Reports: A total of four (4) resident files were reviewed. Files contained admission agreements, Physician's Reports, Appraisals, TB clearance, COVID-19 vaccine cards, Functional Capability Assessment, and emergency information. RCFE complaint poster and Personal rights were observed posted in the facility. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Indoor and outdoor activities are performed twice a week. The facility does not have 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. Physician orders for modified diets are in place. Incident Medical and Dental: Four (4) centrally stored resident medications were observed to have a 30-day supply of medications. Medical and dental transportation is provided by facility staff. See next page. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. The last emergency disaster drill was conducted on 10/14/2023. Residents with Special Health Needs: No residents are receiving home health services or enrolled in hospice care. Postural support physician orders are on file. No bed rails for mobility assistance were observed in resident beds. Individual Service Plans and Appraisals were observed in resident files. No residents have prohibited health conditions. 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 were issued.