Routine inspection·January 3, 2025

On this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Hanna Gough made an unannounced visit to the facility to conduct the required annual inspection. LPAs were greeted and granted entry by facility caregiving staff and facility administrator Fatima Rivera after introducing themselves and stating the purpose of the visit. There are currently four residents in care, two of which are receiving hospice care. LPAs observed residents relaxing in their respective bedrooms and in the facility's common living areas. LPAs accompanied by facility staff toured the physical plant. The facility is a one-story house with an attached garage. The facility has four bedrooms, currently privately occupied. There are three bathrooms throughout the facility, two of which are for use by residents. Two additional rooms on the other side of the house are for use by staff members only and inaccessible to residents. Bedrooms appeared clean and sanitary. Full bed rails are present in two bedrooms. Residents confirmed to be receiving hospice care and plans of care reviewed to include physician orders for the postural supports. LPAs observed all the resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary. Bathrooms are equipped with grab bars and slip mats. Hot water temperature measured at 107.7F and 109F. LPAs observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items are stored in a secure drawer. Fire extinguishers are charged and mounted, with up-to-date maintenance documented on the attached tags. LPAs tested the smoke and carbon monoxide detectors which were found to be operational. The centrally stored medication is located in a locked metal cabinet closet in the dining area. The attached garage is inaccessible to residents and is used for storage and laundry. Cleaning supplies are stored securely in the passageway to the garage. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPAs and facility staff toured the outside of the facility. LPAs observed an shaded outdoor seating areas with furniture for resident use. The perimeter gate on one side of the property is self-latching. LPAs reviewed four resident records which included all necessary components. One physician report for a resident diagnosed with dementia is dated by over a year. Consultation provided. LPAs reviewed resident medication records and prescription orders for all four residents, no discrepancies observed. One resident is assessed to be bedridden per their physician report, which was later confirmed in an interview with the resident's hospice nurse. The facility's current fire clearance does not include a provision for any bedridden residents at this time. Citation issued. LPAs reviewed three staff records which were found to be complete. Training and CPR/First aid training reviewed and up-to-date. All staff are background cleared and associated to the licensed location accurately. Based on the observations made during today’s visit, one type B deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. Consultations provided on attached Advisory Notes form. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.