Routine inspection·June 17, 2024

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1 Year Inspection using the Care Inspection Tool. LPA Cho was greeted and granted entry by Caregiver Ma Alojado and stated the purpose of the visit. The facility is a single story structure located in a residential neighborhood. Facility is licensed to operate for six (6) non-ambulatory and maintains a hospice waiver of four (4). There is one (1) resident under hospice care on today's visit. LPA toured the interior and exterior portions of the facility. There are a total of five resident bedrooms and three resident bathrooms. There is also one staff bedroom and a private staff sun room. There is an additional sun room for the residents. LPA observed the facility to be clean and sanitary. The resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke/carbon monoxide detectors and auditory exit alarms were tested and operational. LPA observed bathrooms to be in good repair, provided with handrails, and a non-skid floor mat. The hot water measured at 116.4, 119.1, and 118.9 degrees Fahrenheit in the resident bathrooms. Facility met the two day perishable and seven day non-perishable food supply. LPA observed medications, toxins, and sharps were inaccessible to the residents. The fire extinguisher was serviced on 08/08/23. For the exterior portion, facility had sufficient seating and shading. The exit door was self-closing and self-latching. LPA observed the emergency disaster supplies including food/water. LPA observed the required "See Something, Say Something' (PUB475) posters in the required size. LPA conducted an audit of six residents' files and two staff files. Discrepancies noted. Staff interviews were conducted. Resident interviews were not conducted due to residents were busy at the time of the interview. Medications were audited for four residents. No discrepancies noted. LPA consulted the following: to obtain a doctor's order for the half rail beds for four (4) residents as well as a physician's reports for five (5) residents, obtain a Tuberculosis Test (TB) for two residents, and to pay the annual licensing fee that was due on June 14, 2024. Based on the observations made during today's visit, deficiencies are being cited as per Title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conducted with Caregivers Imelda Navarro, and Ma Alojado, and a copy of this report including the LIC809C, LIC809Ds, LIC811, and the appeal rights were provided during this visit.