Routine inspection·July 8, 2025

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by Administrator (AD) Corazon Lopez and explained the reason for the visit. The facility is licensed for a capacity of six, approved for six non-ambulatory, with a hospice waiver for two. Currently there are five residents, and there are two on hospice during today's visit. LPA Tea reviewed five resident files. Resident files contained most of the required documents but was not organized and difficult to decipher for the required documents. The staff records were not available. AD Lopez is working on organizing and compiling the staff records together. LPA did observe that staff training is current. The administrator certificate expires on February 28, 2027. LPA Tea along with administrator toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. The home is a one-story facility that consists of four resident bedrooms, one staff private room, 2 full bathrooms, living room, kitchen, dining area, and attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Water temperature measured around 105.8 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards; doorways were free of obstructions. First aid kit had all the required elements Annual Inspection continued LIC809C including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps secured underneath the kitchen sink. LPA also observed toxin substances to be secured and locked and inaccessible to residents underneath the kitchen sink and garage. The fire extinguishers throughout the facility are fully charged. Administrator said she conducts disaster drills but does not keep a record. Kitchen appliances are operational during today's visit. LPA observed emergency food and water supply in the kitchen and garage. There was not enough water for residents in case of emergency. LPA toured the outside grounds. There is a shaded patio area for residents to sit outside. There is a pool in the backyard that is secured and locked. The gates on both sides of the house are self-latching and operational. Facility provides activities based on resident’s personal preference and health condition and limitations, like walking or drawing. Sometimes the residents solve puzzles. At the time of the visit, LPA observed residents watching TV. LPA reviewed medication storage and administration. Medications are stored in a locked cart in the dining area. Medications are being administered per physician orders. LPA interviewed clients regarding their quality of care and spoke to the staff present regarding the care provided. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Administrator Corazon Lopez and a copy of this report LIC809, 809-C, LIC809-D, LIC858, and LIC9102TV were read and provided to the facility