Routine inspection·January 16, 2025

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by caregiving staff after explaining the purpose for the visit. Licensee Carmen Rivas was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Alan Shelley has a valid Administrator certificate which expires on March 24, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents with a hospice waiver for two. The facility is a single-story home with five resident bedrooms, one staff room, two shared resident bathrooms, a living room, a dining room, a kitchen, and an unattached two car garage. LPA accompanied by the Licensee conducted a tour of the physical plant. On today's visit, LPA observed six residents in care, none of which are on hospice, and two caregiving staff present. LPA observed residents eating their breakfast in the dining room. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall by the entryway of the facility. LPA inspected the five resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. All resident beds had clean linens and blankets. LPA observed additional linens are stored in a hallway closet. LPA inspected the two shared resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 116.7 and 118.9 degrees Fahrenheit. LPA observed the kitchen has a two-day perishable and seven-day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed kitchen knives are stored in a locked kitchen cabinet. LPA observed cleaning supplies are stored in a locked kitchen cabinet under the sink. CONTINUED ON LIC809-C A fire extinguisher is located in the kitchen, and it was observed the be charged and serviced as of July 31, 2024. LPA tested the wired smoke detector/carbon monoxide detector which tested operational. LPA observed the facility conducted their last emergency disaster drill on December 15, 2024.The centrally stored medication is kept in a locked cabinet in the kitchen. LPA observed the First Aid kit has all the required components. The unattached two car garage is kept locked and inaccessible to resident. The garage is used for storage and laundry. LPA observed the facility has an emergency food and water supply stored in the garage. LPA and Licensee conducted a tour of the exterior portion of the facility. LPA observed the exterior portion to be clear of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gates on the northside and southside of the facility are self-latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all six resident files. LPA observed that Resident #2 (R2) did not have a Medical Assessment on file. LPA observed that Resident #1 (R1) and Resident #2 (R2) did not have an Admission Agreement on file. LPA reviewed six residents’ medication and medication records. LPA reviewed three staff files. All staff are background cleared and associated to the facility. Based on today's observations, there are deficiencies being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Licensee Carmen Rivas. A copy of the report and Appeal Rights were provided.