Routine inspection·December 3, 2024

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to staff Ricardo Evangelista. Assistant Administrator Danielle Maximo arrived shortly after. The facility is licensed as an RCFE (Residential Care For the Elderly) for four (4) non-ambulatory developmentally disabled adults ages 60 and over. 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: A fire clearance for 4 non-ambulatory residents ages 60 and over was approved on 6/2/2022. Facility handles resident P & I monies and has a current Surety Bond that expires 4/22/2026. 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 and a fire pull alarm in the living room. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The facility has a 1st Aid Kit and Manual. Cleaning supplies, knives, and toxic substances were observed locked and inaccessible to residents. 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. Five (5) staff files were reviewed. Proof of staff training, health and TB clearance, and 1st Aid/CPR training are on file. Proof of in-service training that includes HCBS Final rule was observed in staff files. ****Report narrative continues next page.***** 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 conse nt. Centrally stored medication records are in place. Residents (R1- R4's) medical assessment forms were signed by MD, but not completely filled out. A citation was issued. Resident records included updates that fulfill Home and Community-Based Services (HCBS) Federal Requirements. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Daily activities and weekly calendar of activities was reviewed. 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. One (1) resident has a modified diet plan. Incident Medical and Dental: C en trally stored resident medications were reviewed; containing 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 10/3/2024.. Residents with Special Health Needs: No residents are receiving hospice services or home health services. There are no residents have a restricted health care plan. A deficiency was cited. Exit interview was conducted with Assistant Administrator A copy of the report and appeal rights were issued.