Routine inspection·January 23, 2024

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by staff on duty (S1) Melanie Masecampo. S1 Masecampo notified facility administrator (AD) Carmen Rivas about the visit, however AD was unable to be present, therefore, provided consent for S1 Masecampo to receive and sign the report. For today’s visit, LPA observed a total of 6 residents in care and 2 staff members on duty, LPA observed the Administrator's Certificate for facility administrator (AD) Carmen Rivas which expires on 02/16/2024. LPA De Perio toured the interior and exterior portions of the facility with S1 Masecampo. The facility is a single level structure and is licensed for 6 non-ambulatory residents, of which 2 may be on hospice and 0 bedridden. For this visit, there are a total of 6 residents in care. There are a total of 6 bedrooms, of which are 4 private resident rooms, 1 shared resident room and 1 private room for staff. LPA De Perio toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 3 restrooms of which 1 is for staff and 2 are for residents. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 110.7 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the kitchen. LPA De Perio observed the emergency disaster and evacuation plan, which is posted in the kitchen. Facility had back-up emergency food and water supply, located in the garage. LPA De Perio observed that First Aid Kit had all the required components. LPA De Perio observed that medications and toxins were locked and inaccessible to residents in care. For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. There are 2 gates in the backyard, which both were self-closing and self-latching. No bodies of water were observed. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. No citations were issued. An exit interview was conducted with S1 Masecampo and AD Rivas via phone call. A copy of this report was provided and explained.