Routine inspection·March 7, 2025

At approximately 09:30AM, Licensing Program Analyst (LPA) Ali Deniz and Licensing Program Manager (LPM) Victoria Bertozzi arrived unannounced to conduct a 1-Year Required Visit and met with Staff Member, Elma Cordero. Licensee/Administrator, Silvana Daniel arrived shortly during the visit. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and capacity for 8 non-ambulatory residents. Facility has an approved hospice waiver for 6 individuals. Upon arrival, LPA was informed that there were 4 Residents in care and 1 staff member on-site. At approximately 9:45AM, LPA/Administrator toured the building and did following observations; grounds which was found to be clean and in good repair. Facility had emergency lighting. Facility is a 1 story building with 7 Resident bedrooms, 1 staff bedroom, 4 bathrooms, and common spaces. Facility has an Infection Control plan on file. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. During walk-though LPA/Administrator observed cleaning supplies were accessible to residents in kitchen cabinet under the sink was unlocked and containing cleaning supply. Also, cabinet in the laundry room were containing cleaning supply and lock weren't properly functioning(Citation given). Licensee agrees to remove the cleaning supply under the sink to the laundry cabinet and fix the lock. The facility has a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Facility kitchen, refrigerators and freezers were clean, and food was stored per regulation. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Continued on LIC809C ... Continued from LIC809C Water temperature measured 114.2 degrees F which is within regulation between 105- and 120-degrees F at faucets accessible to residents. Fire extinguishers inspected and charged/last inspected 11/01/2024. Carbon Monoxide detectors were present. Medication is centrally stored and secure. At approximately 11:10AM, LPAs reviewed 4 resident files and all found to be in order and have updated documents on file. Medication records are contained physician's orders for each resident per regulation. Hospice care plans were up to date for each hospice resident. At approximately 11:45AM, LPAs reviewed 2 staff records. LPA observed 1 out of 2 staff files did not have the health screening completed as required by the Health and Safety Code (Citation given). Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducted and documented a disaster drill on 01/20/2025. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC308 – Designation of Facility Responsibility LIC500 - Personnel Report LIC610E - Emergency Disaster Plan Evidence of Updated Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809D, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.