Routine inspection·December 5, 2024

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Licensee, Juanito Estamo, Continual Administrator's Certification expires 03/05/2025. There are currently 5 residents who reside at this home and there is 1 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Smoke alarms were tested and are operational. The home has a carbon monoxide detector. First Aid kit is on site and complete. The facility could not provide Resident 1's hospice care plan. Resident 1 does not have required pre admission appraisal. LPA observed bleach under the sink in Resident 2's bedroom. LPA observed medications on the kitchen table accessible to residents. Resident 3's medication was not properly documented on the Centrally Stored Medication logs. Resident 3 does not have required annually updated medical assessment. Resident 3 did not have an updated Needs and Services plan. Staff 1 has no CPR first aid/ no 501 Employment application, no 503 Health Screening, no training on file. Fire extinguisher is not within the safety regulation period (5/2023.) LPA observed resident hallways bathroom water measures at 104 degrees. The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Licensee, Juanita Estamo, and copy of report left at facility