Routine inspection·September 11, 2024

Licensing Program Analysts (LPAs) Jessica Cho, Jerome Haley, Samer Haddadin arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPAs were greeted by Caregiver Cristy Lucero and were granted entry. Administrator Mark Fisk arrived on premise approximately 8:15am and Erin Fisk arrived shortly after. The Administrator's Certificate for Mark Fisk expires on January 27, 2026 Facility is licensed to serve six (6) non-ambulatory residents and maintains an approved hospice waiver of (4) residents. There are six (6) residents in care during today's visit with two (2) caregivers on duty. LPAs conducted a tour of the physical plant. This is a single story home in a residential neighborhood. The facility consists of six resident bedrooms and four resident bathrooms. There is an additional bedroom occupied by two live-in caregivers. LPAs inspected all common areas including the garage. The garage door was observed to be locked and LPAs were not allowed access into the garage. After several discussions with Administrators Mark and Erin of ensuring LPAs having full access within the property line, LPAs were allowed entry approximately 9:40am. LPA Haley and Haddin observed the garage was filled with clutter. Photographs were taken. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for personal belongings were observed. Bathrooms were found to be clean, sanitary, and operational. The water temperature measured at 118.5, 118.4, 118.7, and 115.8 degrees Fahrenheit. Toxins and disinfectants were unsecured in a pail under the dresser in the hallway. Medications were secured and inaccessible. LPAs observed sufficient two day supply of perishables and seven day supply of non-perishable food. Caregiver #1 (C1) was reminded to label the expiration dates of the pantry items in lieu of the opening date. LPAs toured the exterior portion of the facility. LPAs observed the outdoor passageway. Admins cleared the two bicycles that were obstructing the passageway as well as the shovel and metal bar. LPAs observed sufficient seating and shading. There was no body of water. Facility maintains a fire extinguisher which was mounted, charged, and serviced on October 4, 2023. The auditory devices and smoke/carbon monoxide detectors were tested and operational. LPAs observed sufficient PPE and emergency disaster supplies including food/water. Emergency evacuation drills are conducted quarterly and facility is maintaining a log documenting the drills. The first aid kit contains all necessary elements. LPA observed the required 'See Something, Say Something' (PUB475) poster in the correct size posted in the entry way. Facility maintains a current liability insurance. A working facility telephone number, (949)-998-9191, was tested and remains available. LPAs conducted an audit of six residents' files and two personnel files. A discrepancy was noted for Resident #6 (R6). Medications were audited for six residents. No discrepancies noted. Staff and resident interviews were also conducted. The following items were consulted with Administrator Mark and Erin: to ensure LPA(s) have full access within the property line moving forward, to post the No-Smoking, Oxygen in use sign on the front door and bedroom door for Resident #5 (R5), to ensure disinfectants are secured and inaccessible to all residents, to remove the clutter in the garage, and to update the physician's report for Resident #6 (R6). Based on the observations made during today's visit, deficiencies are being cited as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. See the attached LIC9099-Ds. Advisory Notes are also being issued. An exit interview was conducted with Administrators Mark and Erin Fisk, and a copy of this report including the LIC9099-C & Ds, LIC421IM, Advisories, and the Appeal Rights were provided at exit.