Routine inspection·March 11, 2025

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrator (AD) Shirley Villarmino was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Shirley Villarmino has a valid Administrator certificate which expires on February 14, 2027. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for six. The facility is a one story home with four resident bedrooms, two of which are shared, one staff bedroom, two shared resident bathrooms, a living room, a family room, a dining room, a kitchen, and an attached two car garage. LPA accompanied by the AD conducted a tour of the interior portion of the facility. On today's visit, LPA observed five residents in care, four of which are on hospice, and two care giving staff present. LPA observed residents relaxing in the family room and in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall in the living room. 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 to be stored in a hallway cabinet. 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 107 and 112.1 degrees Fahrenheit. LPA observed the staff bedroom to be locked and inaccessible to residents in care. 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. The five top electric stove was operational. LPA observed knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. CONTINUED ON LIC809-C A fire extinguishers is located in the kitchen and it was observed to be charged and last serviced on September 11, 2023. LPA tested the individual smoke detectors which tested operational. LPA tested the individual carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on February 6, 2025. The centrally stored medication is kept in a locked cabinet in the kitchen. A First Aid kit was observed be stored in the resident hallway and it had all the required components. LPA observed a fire place in the living room and it was observed to not be in operation at the time of visit. The door leading to the attached two car garage is kept locked and inaccessible to residents in care. The garage is used for storage. LPA observed chemicals and toxins to be stored in the locked two car garage. LPA observed additional linens and blankets to be stored in the garage. LPA observed the facility has a three day emergency food and water supply to be stored in the garage. LPA and the AD 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 north side and south side 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 five resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed all five residents’ medication and medication records. LPA reviewed two staff files. LPA observed that Staff #2 did not complete the required annual training for the year of 2024. All staff are background cleared and associated to the facility. Based on today's observations, deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted with Administrator Shirley Villarmino. A copy of the report and Appeal rights were provided.