Non-compliance follow-up·April 1, 2025

At approximately 9:05AM, Licensing Program Analyst (LPA) Ali Deniz arrived at this facility unannounced to conduct a quarterly Legal/Non-Compliance visit. LPA met with facility Licensee/Administrator Madonna Grace Martinez. The facility currently provides care for 6 clients, 6 of 6 which were present at the time of visit. Facility is a 1 story building with 5 Resident bedrooms, 1 staff bedroom, 3 bathrooms, and common spaces. At approximately 09:45AM, LPA toured the building and grounds which was found to be clean and in good repair. 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. LPA observed the amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Staff were in the process of cleaning up after breakfast at the time of this inspection. Toxins are stored in a locked housekeeping closet in the hallway. Water temperature in sink accessible to residents in care measured at 107.6 degrees F which is within the allowable range of 105 to 120 degrees F. Fire extinguishers inspected were charged and last inspected February 2024. However, the fire extinguishers pressure gauge was on green zone mark line. Licensee agrees to service fire extinguishers. Carbon Monoxide and smoke detectors were present and in order. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure. At approximately 10:25M, LPA reviewed 5 resident records and found all in order. 5 of 5 records contained current and signed admission agreements and physician's orders on file. LPA observed 5 out of 5 residents, did not have completed Appraisals & Needs Service Plans on file. Also, resident R3, R4, and R5 did not have pre-appraisals/care plans in file (See LIC809-D page). Medication records are thorough and contained physician's orders for each resident. Continued on LIC809-C… Continued from LIC809… At approximately 11:45AM, LPA reviewed 3 staff files. 3 out of 3 files contained evidence of completed First Aid/CPR certification. 3 of 3 staff files did not contain evidence of completed annual training as required by Title 22 regulation (See LIC809-D page). Administrator agrees to submit proof of training for all staff once trainings complete. Facility has supplies enough to operate for more than 72 hours in an emergency. LPA was presented with proof of current administrator Certificate for Madonna Grace Martinez # expires on 6/20/2025. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by due date of 04/15/2025: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan Copy/Proof of Updated Certificate of 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.