Routine inspection·January 16, 2025

Licensing Program Analyst (LPA) Galarza conducted an unannounced annual inspection visit. The purpose of the visit was explained to caregiver Lucila Aguilar . Assistant Administrator Diana Castellanos shortly after. The facility serves elderly residents ages 60 and older. A hospice and Dementia waiver is in place. Facility is a single-story home located in a residential area consisting of six (6) private bedrooms, two (2) bathrooms, kitchen, dining room, living room, laundry area in attached garage with 2 parking spaces, backyard outdoor covered patio, storage shed in the rear of the backyard. Front yard is landscaped with grass and back yard is landscaped with gravel. Twelve (12) CARE tools domains were reviewed. 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 Dementia and hospice waiver for 3 residents has been approved. A fire clearance for 6 non-ambulatory adults 60 and over; of which one (1) may be bedridden in room 5 or 6. Facility does not handle resident P & I monies. 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 7/4/2025 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. Cleaning supplies and toxic substances are inaccessible to residents. The facility has fully charged fire extinguishers. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The last Emergency Disaster drill was conducted on 10/24/24. Staffing: A total 13 staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expires 6/28/2025. Staff have criminal background clearance and training. Five (5) staff files were reviewed. Proof of staff training, health clearance, and 1st Aid/CPR training us current. Resident Records/Incident Reports: A total of six (6) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent. Medication Administration records are in place. However, documentation errors were observed regarding physician orders. A citation was issued. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. 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. Residents have modified diets. Incident Medical and Dental: Three (3) centrally stored resident medications were reviewed; containing a 30-day supply of medications. Medical and dental transportation is provided by family. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. Residents with Special Health Needs: Three (3) residents are receiving hospice services and two (2) resident receive home health services. Four (4) residents have a Dementia diagnosis. No residents have prohibited health conditions. Full bed rails for mobility assistance were observed in hospice resident's rooms. Resident (R2) had full bed rails without being enrolled in hospice. Staff removed the rails during the visit. A citation was issued. Per California Code of Regulations, Title 22, deficiencies were cited. An exit interview was conducted with Assistant Administrator Diana Castellanos. A copy of the report and appeal rights was provided.